Background: PIRADS score 3 represents a challenge in prostate cancer (PCa) detection with MRI. Our study aimed to evaluate the application of a nomogram on a cohort of patients with PIRADS 3. Methods: We analyzed 286 patients undergoing fusion prostate biopsy from January 2020 to February 2024. Only PIRADS 3 patients were included. Two nomograms, previously developed and based on clinical variables such as age, total PSA (specifically 2–10 ng/mL) and PSA ratio were applied to estimate the probability (Nomograms A and B) for PCa Grade Group (GG) > 3 and GG < 3. Results: Out of the 70 patients available for analysis, 14/70 patients (20%) had PCa, 4/14 were GG 1 (28.6%), 1/14 were GG 2 (7.1%), 5/14 were GG 3 (35.8%), 2/14 were GG 4 (14.3%) and 2/14 were GG 5 (14.3%). The median probability of PCa GG > 3 and GG < 3 was 5% and 33%, respectively. A significant difference (p= 0.033) was found between patients with negative versus positive biopsy for Nomogram B. There was a significant difference (p= 0.029) for Nomogram B comparing patients with GG < 3 and GG > 3. Using a cut-off of 40% for Nomogram B, sensitivity and specificity were 70% and 80%, respectively. Conclusions: This cohort has a low probability of harboring PCa especially ISUP > 3. Nomogram B has good accuracy for discriminating patients with PCa from those with negative biopsy.
背景：在前列腺癌（PCa）的磁共振成像（MRI）检测中，PIRADS评分3级是一个具有挑战性的类别。本研究旨在评估列线图在PIRADS 3级患者队列中的应用价值。方法：我们分析了2020年1月至2024年2月期间接受融合前列腺穿刺活检的286例患者，仅纳入PIRADS 3级病例。应用两种先前开发的列线图（列线图A和B），这些列线图基于年龄、总前列腺特异性抗原（PSA，范围2–10 ng/mL）及PSA比值等临床变量，分别用于评估前列腺癌分级分组（GG）> 3和GG < 3的概率。结果：在可供分析的70例患者中，14例（20%）确诊为前列腺癌，其中GG 1级4例（28.6%）、GG 2级1例（7.1%）、GG 3级5例（35.8%）、GG 4级2例（14.3%）、GG 5级2例（14.3%）。前列腺癌GG > 3和GG < 3的中位概率分别为5%和33%。列线图B在穿刺活检阴性组与阳性组之间显示出显著差异（p=0.033），同时在GG < 3组与GG > 3组的比较中也存在显著差异（p=0.029）。当列线图B以40%为截断值时，其敏感性和特异性分别为70%和80%。结论：该队列患者罹患前列腺癌（尤其是国际泌尿病理学会分级>3级）的概率较低。列线图B在区分前列腺癌患者与穿刺活检阴性患者方面具有良好的准确性。
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