The aim of this study was to assess the predictive value of pre-biopsy blood-based markers in patients undergoing a fusion biopsy for suspicious prostate magnetic resonance imaging (MRI). We identified 365 consecutive patients who underwent MRI-targeted and systematic prostate biopsy for an MRI scored Prostate Imaging-Reporting and Data System Version (PI-RADS) ≥ 3. We evaluated the neutrophil/lymphocyte ratio (NLR), derived neutrophil/lymphocyte ratio (dNLR), platelet/lymphocyte ratio (PLR), systemic immune inflammation index (SII), lymphocyte/monocyte ratio (LMR,) de Ritis ratio, modified Glasgow Prognostic Score (mGPS), and prognostic nutrition index (PNI). Uni- and multivariable logistic models were used to analyze the association of the biomarkers with biopsy findings. The clinical benefits of biomarkers implemented in clinical decision-making were assessed using decision curve analysis (DCA). In total, 69% and 58% of patients were diagnosed with any prostate cancer and Gleason Grade (GG) ≥ 2, respectively. On multivariable analysis, only high dNLR (odds ratio (OR) 2.61, 95% confidence interval (CI) 1.23-5.56, p = 0.02) and low PNI (OR 0.48, 95% CI 0.26-0.88, p = 0.02) remained independent predictors for GG ≥ 2. The logistic regression models with biomarkers reached AUCs of 0.824-0.849 for GG ≥ 2. The addition of dNLR and PNI did not enhance the net benefit of a standard clinical model. Finally, we created the nomogram that may help guide biopsy avoidance in patients with suspicious MRI. In patients with PI-RADS ≥ 3 lesions undergoing MRI-targeted and systematic biopsy, a high dNLR and low PNI were associated with unfavorable biopsy outcomes. Pre-biopsy blood-based biomarkers did not, however, significantly improve the discriminatory power and failed to add a clinical benefit beyond standard clinical factors.

Department of Biomedical Imaging and Image Guided Therapy Medical University of Vienna 1090 Vienna Austria

Department of Special Surgery Jordan University Hospital The University of Jordan Amman 11942 Jordan

Department of Urology 2nd Faculty of Medicine Charles University 150 06 Prague Czech Republic

Department of Urology King Fahad Specialist Hospital Dammam 32253 Saudi Arabia

Department of Urology Luzerner Kantonsspital 6000 Lucerne Switzerland

Department of Urology Medical University of Silesia 41 800 Zabrze Poland

Department of Urology Medical University of Vienna 1090 Vienna Austria

Department of Urology The Jikei University School of Medicine Tokyo 105 8461 Japan

Department of Urology University Hospital Zurich 8091 Zurich Switzerland

Department of Urology University Medical Center Hamburg Eppendorf 20251 Hamburg Germany

Department of Urology University of Texas Southwestern Dallas TX 75390 USA

Department of Urology Weill Cornell Medical College New York NY 10065 USA

Institute for Urology and Reproductive Health Sechenov University 19435 Moscow Russia

Karl Landsteiner Institute of Urology and Andrology 1010 Vienna Austria

Men's Health and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran 19857 17443 Iran

Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz 51666 15731 Iran

Working Group for Diagnostic Imaging in Urology 1090 Vienna Austria

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