在进行前列腺磁共振成像（MRI）时发现前列腺成像报告和数据系统（PI-RADS）3所示的男性进行前列腺活检的决定是具有挑战性的，因为他们具有携带重要前列腺癌症（sPC）的低但仍然相关的风险。为了识别PI-RADS 3病变在前列腺MRI中的sPC的临床预测因素，并分析将前列腺特异性抗原密度（PSAD）纳入活检决策的假设效果，我们分析了一个由十个学术中心组成的回顾性跨国队列，涵盖了2012年2月至2021年4月接受联合前列腺活检（MRI定向活检加系统活检）的1476名男性患者。主要结果是联合活检中检测到sPC（ISUP≥2）。通过回归分析确定了预测因素。应用描述性统计学方法来评估将PSAD纳入活检决策的假设效果。在所有患者中，273/1476（18.5％）被诊断为sPC。MRI定向活检诊断的sPC案例比联合策略少：183/1476（12.4％）与273/1476（18.5％），p <0.01。年龄（比值比[OR] 1.10 [95％置信区间{CI}：1.05-1.15]，p <0.001），以前的阴性活检（OR 0.46 [0.24-0.89]，p = 0.022）和PSAD（p <0.001）被发现是sPC的独立预测因素。将PSAD截止值设置为0.15，可以避免817/1398（58.4％）个活检，但代价是在91（6.5％）名男性中错过sPC。其中局限性包括回顾性设计，由于长时间的纳入期而导致研究队列的异质性，以及MRI的无中央修订。年龄，以前的活检状况和PSAD被发现是具有PI-RADS 3病变在前列腺MRI中的男性sPC的独立预测因素。将PSAD纳入活检决策可以避免不必要的活检。临床参数，如PSAD，需要在前瞻性环境中进行验证。在这项研究中，我们寻找了具有前列腺成像报告和数据系统3所示的前列腺磁共振成像的男性中sPC的临床预测因素。我们确定了年龄，以前的活检情况，特别是前列腺特异性抗原密度作为独立预测因素。版权所有© 2023年欧洲泌尿科协会。由Elsevier B.V.出版。保留所有权利。

Decision of performing prostate biopsy in men with Prostate Imaging Reporting and Data System (PI-RADS) 3 findings in prostate magnetic resonance imaging (MRI) is challenging as they have a low but still relevant risk of harboring significant prostate cancer (sPC).To identify clinical predictors of sPC in men with PI-RADS 3 lesions in prostate MRI and to analyze the hypothetical effect of incorporating prostate-specific antigen density (PSAD) into biopsy decision.We analyzed a retrospective multinational cohort from ten academic centers comprising 1476 men who underwent a combined prostate biopsy (MRI targeted plus systematic biopsy) between February 2012 and April 2021 due to a PI-RADS 3 lesion in prostate MRI.The primary outcome was the detection of sPC (ISUP ≥2) in a combined biopsy. Predictors were identified by a regression analysis. Descriptive statistics were applied to evaluate the hypothetical effect of involving PSAD into biopsy decision.Of all patients, 273/1476 (18.5%) were diagnosed with sPC. MRI-targeted biopsy diagnosed fewer sPC cases than combined strategy: 183/1476 (12.4%) versus 273/1476 (18.5%), p < 0.01. Age (odds ratio [OR] 1.10 [95% confidence interval {CI}: 1.05-1.15], p < 0.001), prior negative biopsy (OR 0.46 [0.24-0.89], p = 0.022), and PSAD (p < 0.001) were found to be independent predictors of sPC. Applying a PSAD cutoff of 0.15, 817/1398 (58.4%) biopsies would have been avoided at the cost of missing sPC in 91 (6.5%) men. Limitations were the retrospective design, heterogeneity of the study cohort due to the long inclusion period, and no central revision of MRI.Age, previous biopsy status, and PSAD were found to be independent predictors of sPC in men with equivocal prostate MRI. Implementation of PSAD into biopsy decision can avoid unnecessary biopsies. Clinical parameters such as PSAD need validation in a prospective setting.In this study, we looked for clinical predictors of significant prostate cancer in men with Prostate Imaging Reporting and Data System 3 lesions in prostate magnetic resonance imaging. We identified age, previous biopsy status, and especially prostate-specific antigen density as independent predictors.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.