Date of Award

January 2019

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Preston C. Sprenkle


Background: Prostate imaging reporting and data system (PI-RADS) is a reporting scheme designed to stratify prostate lesions found on multiparametric MRI (mpMRI) according to their risk of harboring clinically significant prostate cancer (csPCa). In order to reduce the number of unnecessary prostate biopsies and improve pre-biopsy prognostic information, we aimed to evaluate whether there were factors that could further predict the risk of finding csPCa in PI-RADS 3 (P3) and PI-RADS 4 (P4) lesions. Methods: We queried the Yale and University of Alabama at Birmingham (UAB) MRI fusion biopsy databases for men without a prior diagnosis of csPCa and with a P3 or P4 lesion detected on mpMRI who underwent fusion biopsy from Jan. 2015-Oct. 2017. The rates of csPCa were compared between selected study groups. Results: In men with a P3 lesion, the best predictor of a negative biopsy for csPCa was a smaller prostate volume and a lower PSA density. In men with a P4 lesion, additional low-grade PI-RADS lesions lowered the risk of csPCa, while additional high-grade PI-RADS lesions increased the risk of csPCa in a P4 lesion. Conclusions: Certain men with a P3 lesion and a low PSA density may be able to safely avoid prostate biopsy. Evaluating additional regions of interest in a patient with a P4 lesion yields supplementary prognostic information.


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