{
    "abstract": "Voluntary PCa screening frequently results in excessive use of unnecessary diagnostic tests and an increasing risk of detection of indolent PCa and unaffordable costs for the various national health systems. In this scenario, the Italian Society of Urology (Societ\u00e0 Italiana di Urologia, SIU) proposes an organized flow chart guiding physicians to improve early diagnosis of significant PCa avoiding unnecessary diagnostic tests and prostate biopsy.\nAccording to available evidence and international guidelines [i.e., European Association of Urology (EAU), American Association of Urology (AUA) and National Comprehensive Cancer Network (NCCN)] on PCa, a Panel of expert urologists selected by Italian Society of Urology (SIU, Societ\u00e0 Italiana di Urologia) proposed some indications to develop a stepwise diagnostic pathway based on the diagnostic tests mainly used in the clinical practice. The final document was submitted to six expert urologists for external revision and approval. Moreover, the final document was shared with patient advocacy groups.\nIn voluntary men and symptomatic patients with elevated PSA value (>3 ng/mL), the Panel strongly discourage the use of antibiotic agents in absence of urinary tract infection confirmed by urine culture. DRE remains a key part of the urologic physical examination helping urologists to correctly interpret PSA elevation and prioritizing the execution of multiparametric Magnetic Resonance Imaging (mpMRI) in presence of suspicious PCa. Men with negative mpMRI and low clinical suspicion of PSA (PSA density < 0.20 ng/mL/cc, negative DRE findings, no family history) can be further monitored. Men with negative mpMRI and a higher risk of PCa (familial history, suspicious DRE, PSAD>0.20 ng/mL/cc or PSA>20 ng/mL) should be considered for systematic prostate biopsy. While PI-RADS 4-5 lesions represent a strong indication for prostate biopsy, PI-RADS 3 lesions should be further stratified according to PSAD values and prostate biopsy performed when PSAD is higher than 0.20. Accreditation, certification, and quality audits of radiologists and centers performing prostatic mpMRI should be strongly considered. The accessibility and/or the waiting list for MRI examinations should be also evaluated in the diagnostic pathway. The panel suggests performing transperineal or transrectal targeted plus systematic biopsies as standard of care.\nScientific societies must support the use of shared diagnostic pathway with the aim to increase the early detection of significant PCa reducing a delayed diagnosis of advanced PCa. Moreover, a shared diagnostic pathway can reduce the incorrect use of antibiotic, the number of unnecessary laboratory and radiologic examinations as well as of prostate biopsies.",
    "authors": [
        {
            "affiliation": "Urologic Section, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy - vincenzo.ficarra@unime.it.\nUrologic Section, Department of Oncology, AOU G. Martino, Messina, Italy - vincenzo.ficarra@unime.it.",
            "firstname": "Vincenzo",
            "initials": "V",
            "lastname": "Ficarra"
        },
        {
            "affiliation": "Unit of Urology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.",
            "firstname": "Riccardo",
            "initials": "R",
            "lastname": "Bartoletti"
        },
        {
            "affiliation": "Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genoa, Genoa, Italy.",
            "firstname": "Marco",
            "initials": "M",
            "lastname": "Borghesi"
        },
        {
            "affiliation": "Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy.",
            "firstname": "Cosimo",
            "initials": "C",
            "lastname": "DE Nunzio"
        },
        {
            "affiliation": "Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy.",
            "firstname": "Ugo G",
            "initials": "UG",
            "lastname": "Falagario"
        },
        {
            "affiliation": "Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.",
            "firstname": "Giorgio",
            "initials": "G",
            "lastname": "Gandaglia"
        },
        {
            "affiliation": "Unit of Urology, Santa Maria della Misericordia University Hospital, Udine, Italy.",
            "firstname": "Gianluca",
            "initials": "G",
            "lastname": "Giannarini"
        },
        {
            "affiliation": "Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Minervini"
        },
        {
            "affiliation": "Pegaso University, Naples, Italy.",
            "firstname": "Vincenzo",
            "initials": "V",
            "lastname": "Mirone"
        },
        {
            "affiliation": "Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.",
            "firstname": "Francesco",
            "initials": "F",
            "lastname": "Porpiglia"
        },
        {
            "affiliation": "Europa Uomo Italia Nonprofit Organization, Milan, Italy.\nUnit of Urology, ASST Santi Paolo e Carlo, Milan, Italy.",
            "firstname": "Bernardo",
            "initials": "B",
            "lastname": "Rocco"
        },
        {
            "affiliation": "Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Salonia"
        },
        {
            "affiliation": "Fondazione Prevenzione Ricerca Oncologia, Milan, Italy.",
            "firstname": "Paolo",
            "initials": "P",
            "lastname": "Verze"
        },
        {
            "affiliation": "Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy.",
            "firstname": "Giuseppe",
            "initials": "G",
            "lastname": "Carrieri"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.23736/S2724-6051.24.06118-4",
    "journal": "Minerva urology and nephrology",
    "keywords": [],
    "methods": null,
    "publication_date": "2024-09-25",
    "pubmed_id": "39320245",
    "results": "In voluntary men and symptomatic patients with elevated PSA value (>3 ng/mL), the Panel strongly discourage the use of antibiotic agents in absence of urinary tract infection confirmed by urine culture. DRE remains a key part of the urologic physical examination helping urologists to correctly interpret PSA elevation and prioritizing the execution of multiparametric Magnetic Resonance Imaging (mpMRI) in presence of suspicious PCa. Men with negative mpMRI and low clinical suspicion of PSA (PSA density < 0.20 ng/mL/cc, negative DRE findings, no family history) can be further monitored. Men with negative mpMRI and a higher risk of PCa (familial history, suspicious DRE, PSAD>0.20 ng/mL/cc or PSA>20 ng/mL) should be considered for systematic prostate biopsy. While PI-RADS 4-5 lesions represent a strong indication for prostate biopsy, PI-RADS 3 lesions should be further stratified according to PSAD values and prostate biopsy performed when PSAD is higher than 0.20. Accreditation, certification, and quality audits of radiologists and centers performing prostatic mpMRI should be strongly considered. The accessibility and/or the waiting list for MRI examinations should be also evaluated in the diagnostic pathway. The panel suggests performing transperineal or transrectal targeted plus systematic biopsies as standard of care.",
    "title": "Prostate cancer diagnostic pathway in men with lower urinary tract symptoms or performing opportunistic screening: The Italian Society of Urology (SIU) position paper.",
    "xml": "<Element 'PubmedArticle' at 0x7885044a70b0>"
}