COMBINING PROSTATE HEALTH INDEX AND mpMRI DATA (MRI SPECTROSCOPY) TO MANAGE PI-RADS LESIONS AND REDUCE EXCESSIVE BIOPSY, A SINGLE CENTER STUDY
Abstract
To evaluate the values ​​of PHI and PI-RADS findings in the early detection and prediction of prostate cancer, as well as their application in clinical trials, especially when values of PSA are in the „ grey zone„ with negative DRE. 100 patients, men aged 50 years or older with prostate specific antigen 4 to 10 ng/ml („gray zone„) and normal digital rectal examination with suspected prostate cancer were examined, who had undergone biopsy and were divided in two groups. A group with no evidence of PCa (non PCa) and the group with PCa. The performance of PHI and mpMRI PI-RADS score was compared to predict biopsy results and, specifically, the presence of clinically significant prostate cancer (csPCa) using multiple criteria. Among 100 subjects, 21 (21.0%) were diagnosed with PC, including 13 (61.95%) with csPC (Gleason≥7). By the threshold of PHI≥36, the sensitivity, specificity, PPV, and NPV to predict PCa were 100%, 68.35%, 45.65%, and 100%, respectively. The best cut-off (PHI) was 42.8% with sensitivity 85.7% and specificity 86.1%. The area under the receiver operator characteristic curve (AUC) of combining PHI and mpMRI was greater than that of PHI alone (0.993 vs. 0.954, p=0.002) and mpMRI alone (0.993 vs. 0.976, p=0.025). Comparing the performance in the identification of clinically significant prostate cancer (csPCa), we found that PHI ≥ 73.04 and PI-RADS score ≥ 4 were able to identify csPCa (Gleason score ≥ 7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI≥36.0, 50% of biopsy could be avoided with one csPCa patient being missed. The analyzed correlation between PHI and PI-RADS score was statistically significant (p<0.0001). According to the value of Spearman's coefficient, R=0.748, the correlation is positive, i.e. direct, and they showed that with an increase in the value of the prostatic health index, (PHI) the PI-RADS score increases, and vice versa. The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with PHI or mpMRI alone.
Keywords: Prostate health index, mpMRI PI-RADS, detection of prostate cancer.
References
1.Rawla P. Epidemiology of prostate cancer. World J Oncol. 2019;10: 63–89.
2.Tompson, I. M. et al. Prevalence of prostate cancer among men with a prostate-specifc antigen level < or = 4.0 ng per milliliter. N. Engl. J. Med. 2004; 350, 2239–2246.
3. Hori, S., Blanchet, J. S. & McLoughlin, J. From prostate-specifc antigen (PSA) to precursor PSA (proPSA) isoforms: a review of the emerging role of proPSAs in the detection and management of early prostate cancer. BJU Int. 2013;112, 717–728.
4.Visser, W.C.H.; de Jong, H.; Melchers, W.J.G.; Mulders, P.F.A.; Schalken, J.A. Commercialized Blood-, Urinary- and Tissue-Based Biomarker Tests for Prostate Cancer Diagnosis and Prognosis. Cancers 2020, 12, 3790. [CrossRef] [PubMed.
5.Jansen FH, van Schaik RHN, Kurstjens J, Horninger W, Klocker H, Bektic J, Wildhagen MF, Roobol MJ, Bangma CH, Bartsch G. Prostate-Specific Antigen (PSA) Isoform p2PSA in Combination with Total PSA and Free PSA Improves Diagnostic Accuracy in Prostate Cancer Detection. European Urology. 2010;57(6):921-7.
6.Lazzeri M, Lughezzani G, Haese A, McNicholas T, de la Taille A, Buffi NM, Cardone P, Hurle R, Casale P, Bini V, Redorta JP, Graefen M, Guazzoni G. Clinical performance of prostate health index in men with tPSA>10ng/ml: Results from a multicentric European study. Urologic Oncology: Seminars and Original Investigations. 2016;34 (9):415.e13-. e19.
7.Wei J.T., Barocas D., Carlsson S., Coakley F, Eggener S, Etzioni R, et al. Early detection of prostate cancer: AUA/SUO guideline part II: considerations for a prostate biopsy. J Urol. 2023 [PubMed] [Google Scholar]
8.Kasivisvanathan, V.; Rannikko, A.S.; Borghi, M.; Panebianco, V.; Mynderse, L.A.; Vaarala, M.H.; Briganti, A.; Budaus, L.; Hellawell, G.; Hindley, R.G.; et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N. Engl. J. Med. 2018, 378, 1767–1777. [CrossRef]
9.Mottet, N.; van den Bergh, R.C.N.; Briers, E.; Van den Broeck, T.; Cumberbatch, M.G.; De Santis, M.; Fanti, S.; Fossati, N.; Gandaglia, G.; Gillessen, S.; et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur. Urol. 2021, 79, 243–262. [CrossRef] [PubMed]
10.Grey, A.D.; Chana, M.S.; Popert, R.; Wolfe, K.; Liyanage, S.H.; Acher, P.L. Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting. BJU Int. 2015, 115, 728–735. [CrossRef] [PubMed]
11.Ferro M, Crocetto F, Bruzzese D. Imbriaco M, Fusco F. Longo N, et al Prostate health index and multiparametric MRI: partners in crime fighting over-diagnosis and overtreatment in prostate cancer, Cancers (Basel) 2021:13
12.McDonald ML, Parsons JK. The case for tailored prostate cancer screening: An NCCN perspective. J Natl Compr Canc Netw (2015) 13:1576–83. doi: 10.6004/ jnccn.2015.0183
13.Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, Taneja SS, Thoeny H, Villeirs G, Villers A (2015) Can clinically signifcant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 68(6):1045–1053. https://doi.org/10.1016/j.eurur o.2015.01.013
14.Loeb S, Shin SS, Broyles DL, Wei JT, Sanda M, Klee G, Partin AW, Sokoll L, Chan DW, Bangma CH, van Schaik RHN, Slawin KM, Marks LS, Catalona WJ (2017) Prostate health index improves multivariable risk prediction of aggressive prostate cancer. BJU Int 120(1):61–68. https://doi.org/10.1111/bju.13676
15. Network NCC (2018) NCCN guideline prostate cancer early detection. version 2. 2018. https://www.nccn.org/professionals/physi cian_gls/pdf/prostate_detection.pdf. Accessed Dec 09 2018
16. Chiu PK, Ng CF, Semjonow A, Zhu Y, Vincendeau S, Houlgatte A, Lazzeri M, Guazzoni G, Stephan C, Haese A, Bruijne I, Teoh JY, Leung CH, Casale P, Chiang CH, Tan LG, Chiong E, Huang CY, Wu HC, Nieboer D, Ye DW, Bangma CH, Roobol MJ (2019) A multicentre evaluation of the role of the prostate health index (PHI) in regions with difering prevalence of prostate cancer: adjustment of PHI reference ranges is needed for European and Asian settings. Eur Urol 75(4):558–561. https://doi.org/10.1016/j.eururo.2018.10.047.
17. Gnanapragasam VJ, Burling K, George A, Stearn S, Warren A, Barrett T, Koo B, Gallagher FA, Doble A, Kastner C, Parker RA (2016) The prostate health index adds predictive value to multi-parametric MRI in detecting signifcant prostate cancers in a repeat biopsy population. Sci Rep 6:35364
18. Hsieh, P.F.; Li, W.J.; Lin, W.C.; Chang, H.; Chang, C.H.; Huang, C.P.; Yang, C.R.; Chen, W.C.; Chang, Y.H.; Wu, H.C. Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population. World J. Urol. 2020, 38, 1207–1214. [CrossRef]
19.Tosoian, J.J.; Druskin, S.C.; Andreas, D.; Mullane, P.; Chappidi, M.; Joo, S.; Ghabili, K.; Agostino, J.; Macura, K.J.; Carter, H.B.; et al. Use of the Prostate Health Index for detection of prostate cancer: Results from a large academic practice. Prostate Cancer Prostatic Dis. 2017, 20, 228–233. [CrossRef] [PubMed].
20.Fan, Y.H.; Pan, P.H.; Cheng, W.M.; Wang, H.K.; Shen, S.H.; Liu, H.T.; Cheng, H.M.; Chen, W.R.; Huang, T.H.; Wei, T.C.; et al. The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer. Sci. Rep. 2021, 11, 1286. [CrossRef] [PubMed].
21.Stejskal, J.; Adamcova, V.; Zalesky, M.; Novak, V.; Capoun, O.; Fiala, V.; Dolejsova, O.; Sedlackova, H.; Vesely, S.; Zachoval, R. The predictive value of the prostate health index vs. multiparametric magnetic resonance imaging for prostate cancer diagnosis in prostate biopsy. World J. Urol. 2021, 39, 1889–1895. [CrossRef]
22.Tan, T.W.; Png, K.S.; Lee, C.H.; Yuwono, A.; Yeow, Y.; Chong, K.T.; Lee, Y.M.; Tan, C.H.; Tan, Y.K. MRI Fusion-Targeted Transrectal Prostate Biopsy and the Role of Prostate-Specific Antigen Density and Prostate Health Index for the Detection of Clinically Significant Prostate Cancer in Southeast Asian Men. J. Endourol. 2017, 31, 1111–1116. [CrossRef] [PubMed].
23.Rosenkrantz AB, Verma S, Choyke P, Eberhardt SC, Eggener SE, Gaitonde K, Haider MA, Margolis DJ, Marks LS, Pinto P, Sonn GA, Taneja SS: Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. 2016: J Urol 196(6):1613–1618. https://doi.org/10.1016/j.juro.2016.06.079.
24.Schoots, I.G. MRI in early prostate cancer detection: How to manage indeterminate or equivocal PI-RADS 3 lesions? Transl. Androl. Urol. 2018, 7, 70–82. [CrossRef] [PubMed].
25. Sathianathen, N.J.; Omer, A.; Harriss, E.; Davies, L.; Kasivisvanathan, V.; Punwani, S.; Moore, C.M.; Kastner, C.; Barrett, T.; Van Den Bergh, R.C.; et al. Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis. Eur. Urol. 2020, 78, 402–414. [CrossRef] [PubMed]
26.Ahmed, H. U. et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confrmatory study. Lancet 2017; 389, 815–822
27.Norris, J.M.; Carmona Echeverria, L.M.; Bott, S.R.J.; Brown, L.C.; Burns-Cox, N.; Dudderidge, T.; El-Shater Bosaily, A.; Frangou, E.; Freeman, A.; Ghei, M.; et al. What Type of Prostate Cancer Is Systematically Overlooked by Multiparametric Magnetic Resonance Imaging? An Analysis from the PROMIS Cohort. Eur. Urol. 2020, 78, 163–170. [CrossRef] [PubMed].
28. Stephan C, Vincendeau S, Houlgatte A, Cammann H, Jung K, Semjonow A Multicenter evaluation of [−2] proprostatespecifc antigen and the prostate health index for detecting prostate cancer. Clin Chem 2013; 59(1):306–314.
29. Loeb S, Sanda MG, Broyles DL, Shin SS, Bangma CH, Wei JT, Partin AW, Klee GG, Slawin KM, Marks LS The prostate health index selectively identifes clinically signifcant prostate cancer. J Urol 2015; 193(4):1163–1169.
30. Sedlackova, H.; Dolejsova, O.; Hora, M.; Ferda, J.; Hes, O.; Topolcan, O.; Fuchsova, R.; Kucera, R. Prostate Cancer Diagnostic Algorithm as a "Road Map" from the First Stratification of the Patient to the Final Treatment Decision. Life 2021, 11, 324. [CrossRef].
31.Pastor-Navarro, B.; Rubio-Briones, J.; Borque-Fernando, A.; Esteban, L.M.; Dominguez-Escrig, J.L.; Lopez-Guerrero, J.A. Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice. Int. J. Mol. Sci. 2021, 22, 6266. [CrossRef] [PubMed].
32. Ferro, M.; De Cobelli, O.; Lucarelli, G.; Porreca, A.; Busetto, G.M.; Cantiello, F.; Damiano, R.; Autorino, R.; Musi, G.; Vartolomei, M.D.; et al. Beyond PSA: The Role of Prostate Health Index (phi). Int. J. Mol. Sci. 2020, 21, 1184. [CrossRef].
2.Tompson, I. M. et al. Prevalence of prostate cancer among men with a prostate-specifc antigen level < or = 4.0 ng per milliliter. N. Engl. J. Med. 2004; 350, 2239–2246.
3. Hori, S., Blanchet, J. S. & McLoughlin, J. From prostate-specifc antigen (PSA) to precursor PSA (proPSA) isoforms: a review of the emerging role of proPSAs in the detection and management of early prostate cancer. BJU Int. 2013;112, 717–728.
4.Visser, W.C.H.; de Jong, H.; Melchers, W.J.G.; Mulders, P.F.A.; Schalken, J.A. Commercialized Blood-, Urinary- and Tissue-Based Biomarker Tests for Prostate Cancer Diagnosis and Prognosis. Cancers 2020, 12, 3790. [CrossRef] [PubMed.
5.Jansen FH, van Schaik RHN, Kurstjens J, Horninger W, Klocker H, Bektic J, Wildhagen MF, Roobol MJ, Bangma CH, Bartsch G. Prostate-Specific Antigen (PSA) Isoform p2PSA in Combination with Total PSA and Free PSA Improves Diagnostic Accuracy in Prostate Cancer Detection. European Urology. 2010;57(6):921-7.
6.Lazzeri M, Lughezzani G, Haese A, McNicholas T, de la Taille A, Buffi NM, Cardone P, Hurle R, Casale P, Bini V, Redorta JP, Graefen M, Guazzoni G. Clinical performance of prostate health index in men with tPSA>10ng/ml: Results from a multicentric European study. Urologic Oncology: Seminars and Original Investigations. 2016;34 (9):415.e13-. e19.
7.Wei J.T., Barocas D., Carlsson S., Coakley F, Eggener S, Etzioni R, et al. Early detection of prostate cancer: AUA/SUO guideline part II: considerations for a prostate biopsy. J Urol. 2023 [PubMed] [Google Scholar]
8.Kasivisvanathan, V.; Rannikko, A.S.; Borghi, M.; Panebianco, V.; Mynderse, L.A.; Vaarala, M.H.; Briganti, A.; Budaus, L.; Hellawell, G.; Hindley, R.G.; et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N. Engl. J. Med. 2018, 378, 1767–1777. [CrossRef]
9.Mottet, N.; van den Bergh, R.C.N.; Briers, E.; Van den Broeck, T.; Cumberbatch, M.G.; De Santis, M.; Fanti, S.; Fossati, N.; Gandaglia, G.; Gillessen, S.; et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur. Urol. 2021, 79, 243–262. [CrossRef] [PubMed]
10.Grey, A.D.; Chana, M.S.; Popert, R.; Wolfe, K.; Liyanage, S.H.; Acher, P.L. Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting. BJU Int. 2015, 115, 728–735. [CrossRef] [PubMed]
11.Ferro M, Crocetto F, Bruzzese D. Imbriaco M, Fusco F. Longo N, et al Prostate health index and multiparametric MRI: partners in crime fighting over-diagnosis and overtreatment in prostate cancer, Cancers (Basel) 2021:13
12.McDonald ML, Parsons JK. The case for tailored prostate cancer screening: An NCCN perspective. J Natl Compr Canc Netw (2015) 13:1576–83. doi: 10.6004/ jnccn.2015.0183
13.Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, Taneja SS, Thoeny H, Villeirs G, Villers A (2015) Can clinically signifcant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 68(6):1045–1053. https://doi.org/10.1016/j.eurur o.2015.01.013
14.Loeb S, Shin SS, Broyles DL, Wei JT, Sanda M, Klee G, Partin AW, Sokoll L, Chan DW, Bangma CH, van Schaik RHN, Slawin KM, Marks LS, Catalona WJ (2017) Prostate health index improves multivariable risk prediction of aggressive prostate cancer. BJU Int 120(1):61–68. https://doi.org/10.1111/bju.13676
15. Network NCC (2018) NCCN guideline prostate cancer early detection. version 2. 2018. https://www.nccn.org/professionals/physi cian_gls/pdf/prostate_detection.pdf. Accessed Dec 09 2018
16. Chiu PK, Ng CF, Semjonow A, Zhu Y, Vincendeau S, Houlgatte A, Lazzeri M, Guazzoni G, Stephan C, Haese A, Bruijne I, Teoh JY, Leung CH, Casale P, Chiang CH, Tan LG, Chiong E, Huang CY, Wu HC, Nieboer D, Ye DW, Bangma CH, Roobol MJ (2019) A multicentre evaluation of the role of the prostate health index (PHI) in regions with difering prevalence of prostate cancer: adjustment of PHI reference ranges is needed for European and Asian settings. Eur Urol 75(4):558–561. https://doi.org/10.1016/j.eururo.2018.10.047.
17. Gnanapragasam VJ, Burling K, George A, Stearn S, Warren A, Barrett T, Koo B, Gallagher FA, Doble A, Kastner C, Parker RA (2016) The prostate health index adds predictive value to multi-parametric MRI in detecting signifcant prostate cancers in a repeat biopsy population. Sci Rep 6:35364
18. Hsieh, P.F.; Li, W.J.; Lin, W.C.; Chang, H.; Chang, C.H.; Huang, C.P.; Yang, C.R.; Chen, W.C.; Chang, Y.H.; Wu, H.C. Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population. World J. Urol. 2020, 38, 1207–1214. [CrossRef]
19.Tosoian, J.J.; Druskin, S.C.; Andreas, D.; Mullane, P.; Chappidi, M.; Joo, S.; Ghabili, K.; Agostino, J.; Macura, K.J.; Carter, H.B.; et al. Use of the Prostate Health Index for detection of prostate cancer: Results from a large academic practice. Prostate Cancer Prostatic Dis. 2017, 20, 228–233. [CrossRef] [PubMed].
20.Fan, Y.H.; Pan, P.H.; Cheng, W.M.; Wang, H.K.; Shen, S.H.; Liu, H.T.; Cheng, H.M.; Chen, W.R.; Huang, T.H.; Wei, T.C.; et al. The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer. Sci. Rep. 2021, 11, 1286. [CrossRef] [PubMed].
21.Stejskal, J.; Adamcova, V.; Zalesky, M.; Novak, V.; Capoun, O.; Fiala, V.; Dolejsova, O.; Sedlackova, H.; Vesely, S.; Zachoval, R. The predictive value of the prostate health index vs. multiparametric magnetic resonance imaging for prostate cancer diagnosis in prostate biopsy. World J. Urol. 2021, 39, 1889–1895. [CrossRef]
22.Tan, T.W.; Png, K.S.; Lee, C.H.; Yuwono, A.; Yeow, Y.; Chong, K.T.; Lee, Y.M.; Tan, C.H.; Tan, Y.K. MRI Fusion-Targeted Transrectal Prostate Biopsy and the Role of Prostate-Specific Antigen Density and Prostate Health Index for the Detection of Clinically Significant Prostate Cancer in Southeast Asian Men. J. Endourol. 2017, 31, 1111–1116. [CrossRef] [PubMed].
23.Rosenkrantz AB, Verma S, Choyke P, Eberhardt SC, Eggener SE, Gaitonde K, Haider MA, Margolis DJ, Marks LS, Pinto P, Sonn GA, Taneja SS: Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. 2016: J Urol 196(6):1613–1618. https://doi.org/10.1016/j.juro.2016.06.079.
24.Schoots, I.G. MRI in early prostate cancer detection: How to manage indeterminate or equivocal PI-RADS 3 lesions? Transl. Androl. Urol. 2018, 7, 70–82. [CrossRef] [PubMed].
25. Sathianathen, N.J.; Omer, A.; Harriss, E.; Davies, L.; Kasivisvanathan, V.; Punwani, S.; Moore, C.M.; Kastner, C.; Barrett, T.; Van Den Bergh, R.C.; et al. Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis. Eur. Urol. 2020, 78, 402–414. [CrossRef] [PubMed]
26.Ahmed, H. U. et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confrmatory study. Lancet 2017; 389, 815–822
27.Norris, J.M.; Carmona Echeverria, L.M.; Bott, S.R.J.; Brown, L.C.; Burns-Cox, N.; Dudderidge, T.; El-Shater Bosaily, A.; Frangou, E.; Freeman, A.; Ghei, M.; et al. What Type of Prostate Cancer Is Systematically Overlooked by Multiparametric Magnetic Resonance Imaging? An Analysis from the PROMIS Cohort. Eur. Urol. 2020, 78, 163–170. [CrossRef] [PubMed].
28. Stephan C, Vincendeau S, Houlgatte A, Cammann H, Jung K, Semjonow A Multicenter evaluation of [−2] proprostatespecifc antigen and the prostate health index for detecting prostate cancer. Clin Chem 2013; 59(1):306–314.
29. Loeb S, Sanda MG, Broyles DL, Shin SS, Bangma CH, Wei JT, Partin AW, Klee GG, Slawin KM, Marks LS The prostate health index selectively identifes clinically signifcant prostate cancer. J Urol 2015; 193(4):1163–1169.
30. Sedlackova, H.; Dolejsova, O.; Hora, M.; Ferda, J.; Hes, O.; Topolcan, O.; Fuchsova, R.; Kucera, R. Prostate Cancer Diagnostic Algorithm as a "Road Map" from the First Stratification of the Patient to the Final Treatment Decision. Life 2021, 11, 324. [CrossRef].
31.Pastor-Navarro, B.; Rubio-Briones, J.; Borque-Fernando, A.; Esteban, L.M.; Dominguez-Escrig, J.L.; Lopez-Guerrero, J.A. Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice. Int. J. Mol. Sci. 2021, 22, 6266. [CrossRef] [PubMed].
32. Ferro, M.; De Cobelli, O.; Lucarelli, G.; Porreca, A.; Busetto, G.M.; Cantiello, F.; Damiano, R.; Autorino, R.; Musi, G.; Vartolomei, M.D.; et al. Beyond PSA: The Role of Prostate Health Index (phi). Int. J. Mol. Sci. 2020, 21, 1184. [CrossRef].
Published
2023-12-27
How to Cite
KRSTEV, Toni et al.
COMBINING PROSTATE HEALTH INDEX AND mpMRI DATA (MRI SPECTROSCOPY) TO MANAGE PI-RADS LESIONS AND REDUCE EXCESSIVE BIOPSY, A SINGLE CENTER STUDY.
Journal of Morphological Sciences, [S.l.], v. 6, n. 3, p. 203-216, dec. 2023.
ISSN 2545-4706.
Available at: <https://jms.mk/jms/article/view/vol6no3-27>. Date accessed: 21 dec. 2024.
Issue
Section
Articles
