PI-RADS 3 Independently Predicts Negative Repeat Biopsy; PSA Density Stratifies Only for PI-RADS 4–5

PI-RADS 3 lesions independently predict negative repeat prostate biopsy (OR 0.58, 95% CI 0.36–0.93) with 19.0% cancer detection. PSA density stratified risk for PI-RADS 4–5 (33.8% vs 62.4%) but not for PI-RADS 3 (16.2% vs 20.7%). Retrospective, 684 patients.

• Retrospective, single-center study of 684 men undergoing repeat MRI-guided prostate biopsy (2015–2022).
• PSAD significantly stratified cancer detection in PI-RADS 4–5 (33.8% vs 62.4%, p<0.001) but not in PI-RADS 3 (p=0.564).
• Limitation: retrospective design, single center, inherent selection bias in a repeat-biopsy cohort; no external validation.

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