PI-RADSv2.1 combined with PSA density for optimizing prostate biopsy decisions: a retrospective analysis

The use of the PI-RADS v2.1 score combined with PSAD is recommended as an indication for prostate biopsy: (1) For patients with PI-RADS scores of 1-2, biopsy can be avoided if PSAD is < 0.30 ng/(mL·cm³), whereas biopsy is recommended if PSAD is ≥ 0.30 ng/(mL·cm³). (2) For patients with a PI-RADS score of 3, biopsy can be avoided if PSAD is < 0.15 ng/(mL·cm³), but it is recommended if PSAD is ≥ 0.15 ng/(mL·cm³). (3) Patients with a PI-RADS score of 4 are recommended for biopsy in all cases. (4) For patients with a PI-RADS score of 5, biopsy is recommended if PSAD is < 2.00 ng/(mL·cm³), but empirical initiation of treatment without biopsy may be considered if PSAD ≥ 2.00 ng/(mL·cm³), subject to ethics committee approval. Using these criteria, 40% (186/462) of patients in this study could potentially avoid prostate biopsy.