Asian-American men have distinctly different prostate cancer epidemiology compared to other men. The role of multiparametric magnetic resonance imaging and targeted biopsy for elevated PSA in this population has not been assessed. We sought to define imaging and targeted biopsy outcomes in Asian-American men compared to other men.

A multicenter, prospective cohort of men who underwent magnetic resonance imaging-targeted with systematic biopsy for elevated prostate specific antigen was accrued. Outcome of interest was diagnosis of clinically significant prostate cancer (Gleason Grade Group≥2), stratified by PI-RADS score and history of negative biopsy. Multivariable logistic regression was used to assess the effect of Asian-American race on cancer detection.

Of 2,571 men, 275 (11%) were Asian-American. Clinically significant prostate cancer was detected in 37% of Asian-American men compared to 48% in men of other races (p<0.001). Asian-American men were also less likely to be diagnosed with grade group 1 cancer (12% vs 18%, p=0.007). Additionally, there was significantly lower detection of significant cancer for PIRADS 3 in Asian-Americans vs. other races (12% vs. 21%, p=0.032). In adjusted analysis, Asian-Americans were less likely to be diagnosed with both significant cancer (OR 0.57, 95% CI 0.42-0.79, p<0.001) and grade group 1 cancer (OR 0.57, 95% CI 0.38-0.84, p=0.005) compared to non-Asians.

Asian-Americans are less likely to be diagnosed with clinically significant prostate cancer on targeted biopsy, illustrating different performance of PI-RADS in this population. Conventional risk assessment tools should be modified when selecting Asian-American men for biopsy.

The Journal of urology. 2019 Sep 10 [Epub ahead of print]

Michael D Gross, Leonard S Marks, Geoffrey A Sonn, David A Green, Gerald J Wang, Jonathan E Shoag, Elizabeth Cabezon, Daniel J Margolis, Brian D Robinson, Jim C Hu

Brady Department of Urology, Weill Cornell Medicine, New York, New York., Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, California., Department of Urology, Stanford University School of Medicine, Stanford, California., Department of Radiology, Weill Cornell Medicine, New York, New York., Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.