Daniel Hettel, Aimee Kestranek, Robert Rochelle, Mark Stovsky,
Eric Klein,*, Cleveland, OHhttps://www.auajournals.org/doi/abs/10.1097/JU.0000000000001972.20
INTRODUCTION AND OBJECTIVE: We assessed the clinical
utility of IsoPSA a novel test to assess the risk of high-grade prostate
cancer e to determine its effect on reducing unneeded prostate biopsies in a real-world setting.
METHODS: 636 patients were enrolled by 58 providers practicing across a range of academic and community settings. IsoPSA was
made available to all providers, including those intending to order
a prostate biopsy and/or prostate MRI for their patients. 516 patients met
the IsoPSA Indication For Use (PSA 4 ng/ml, age 50 yo), 313 of
whom were 65 years of age. After reviewing the medical records for
patients who ultimately received IsoPSA, the updated numbers of biopsy and/or MRI recommendations in this cohort were compared to
their pre-IsoPSA recommendations.
RESULTS: Among the 516 patients ultimately receiving IsoPSA
tests, 211 were recommended for a biopsy following IsoPSA testing vs.
429 prior to the test, a 51% reduction. An 11% reduction in MRIs recommended was also noted. Final recommendations aligned closely with
IsoPSA indices, with 178 of the 211 patients (84%) ultimately recommended for biopsy having IsoPSA indices above the IsoPSA threshold
vs. only 33 below the IsoPSA threshold. Conversely, 273 of the 291
patients (94%) not recommended for biopsy had indices below the
IsoPSA threshold vs. only 18 above the IsoPSA threshold. (14 patient
records were incomplete, unclear, or pending MRI results or patient
discussions.)
CONCLUSIONS: Use of IsoPSA in a real-world setting reduced
recommendations for prostate biopsy by 51% and prostate MRI by 11%.
These reductions should translate to improved patient outcomes and
realized cost savings.