Dr. Hafron on IsoPSA with PI-RADS for prostate biopsy decision-making

In this interview, Jason M. Hafron, MD, highlights the background and key findings from the study, “Using IsoPSA with prostate imaging reporting and data system score may help refine biopsy decision making in patients with elevated PSA.” Hafron is the chief medical officer and medical director of clinical research at the Michigan Institute of Urology, PC, and a professor of urology at the William Beaumont School of Medicine, Oakland University.

Video Transcript:

There was a very interesting study published. I think it was an interesting trial because it gave us real practical numbers that we can use in everyday practice on how to integrate IsoPSA with MRI. I think frequently we are faced with an MRI that has a PI-RADS 1, 2, or 3, but the patient has a rising PSA or there is suspicion that that PI-RADS 3 lesion might be significant. Historically, we've known that it may or may not be significant and it's vague on how to manage the PI-RADS 3 lesions.

What this study looked at–and it was a single center Cleveland Clinic dataset that they looked at with over 200 men–is that when you apply IsoPSA or integrate it into your MRI, you can actually improve the performance of both the IsoPSA as well as the MRI. So, getting back to that patient with the PI-RADS 3 lesion, if they have a negative IsoPSA, an IsoPSA less than 6 and a PI-RADS 3 lesion, the chance of that patient having clinically significant prostate cancer is less than 4%. If they have an abnormal IsoPSA greater than 6, that can go up to 16%. So, that's very helpful.

Also, it's very helpful in the patient with a PI-RADS 1 or 2. If they have a IsoPSA less than 6 or a normal Iso, their risk of prostate cancer is 2%. So, that's a pretty strong note to leave those patients alone. If they have an abnormal IsoPSA, that percentage goes up to about 8%, but that's a discussion you can have with your patient.

The key from this paper is that now we have some good numbers to discuss with patients to decide on what's the best path forward, whether we need to biopsy or not. I think it's also very fair–and it's in the discussion and the conclusions of the paper, and every case is different–but if you have a PI-RADS 4 or 5, those patients probably should be biopsied regardless of the IsoPSA. Again, the importance of this paper to clinical practice is that it gives us real numbers on what the likelihood is of cancer in those patients with PI-RADS 3 or less.

This transcription has been edited for clarity.