Editing AUA: Early Detection of Prostate Cancer (2023) (section)

=== Biopsy threshold ===
*'''<span style="color:#ff0000">May be tailored for select patients, similar to risk-stratified re-screening intervals</span>'''
**'''For patients with BRCA mutations, biopsy referral threshold should be 3 ng/mL'''
*'''<span style="color:#ff0000">Clinicians and patients may use validated risk calculators to inform the SDM process regarding prostate biopsy</span>'''
**'''<span style="color:#ff0000">Pre-biopsy risk calculators</span>'''
*** [https://www.prostatecancer-riskcalculator.com/seven-prostate-cancer-risk-calculators ERSPC]
***[https://riskcalc.org/PCPTRC/ PCPT V2]
*** [https://riskcalc.org/PBCG/ PBCG]
**** In one study, investigators compared PBCG with PCPT and concluded that PCPT performed better in minority groups.
*PSA velocity should not be used as sole indication for secondary biomarker, imaging, or a biopsy.
*'''Adjunctive urine or serum markers may be used when further risk stratification would influence the decision regarding whether to proceed with biopsy.'''
** Several blood and urine markers are available, alone or in combination, to further risk stratify patients with a mildly elevated PSA, typically between 2.5 and 10 ng/mL.
*** '''Serum based'''
****'''Percent free PSA'''
*****Most widely available adjunctive test
*****Lower percent free PSA is associated with greater likelihood of identifying prostate cancer on biopsy.
**** '''PSA density'''
*****Higher PSA density (serum PSA [ng/mL] divided by imaging measures of prostate volume [cc]) is associated with the risk of identifying clinically significant prostate cancer on biopsy
***** The Panel recognizes the continuous nature of risk associated with the spectrum of PSA density values and cautions against use of threshold values in isolation
****4Kscore
****IsoPSA
****Proclarix
****PHI
****STHLM-3
***'''Urine based'''
****Post-DRE Urine
*****PCA3
*****MPS
*****SelectMDx
*****TMPRSS:ERG
****Urine
*****ExoDx Prostate Intelliscore
*****MiR Sentinel
****Tissue
*****Confirm MDx
*** Such tests may be of value among patients with modestly elevated PSA tests, especially in patients with a prior negative biopsy in whom PSA alone is not recommended as the sole trigger for rebiopsy.
*'''When the risk of clinically significant prostate cancer is sufficiently low based on available clinical, laboratory, and imaging data, clinicians and patients may forgo near-term prostate biopsy.'''