131276 20260112133138.0 doi 10.3390/jpm14020130 sideral 136771 ART-2024-136771 eng Morote, Juan Investigating efficient risk-stratified pathways for the early detection of clinically significant prostate cancer 2024 Access copy available to the general public Unrestricted Risk-stratified pathways (RSPs) are recommended by the European Association of Uro-logy (EAU) to improve the early detection of clinically significant prostate cancer (csPCa). RSPs can reduce magnetic resonance imaging (MRI) demand, prostate biopsies, and the over-detection of insignificant PCa (iPCa). Our goal is to analyze the efficacy and cost-effectiveness of several RSPs by using sequential stratifications from the serum prostate-specific antigen level and digital rectal examination, the Barcelona risk calculators (BCN-RCs), MRI, and Proclarix™. In a cohort of 567 men with a serum PSA level above 3.0 ng/mL who underwent multiparametric MRI (mpMRI) and targeted and/or systematic biopsies, the risk of csPCa was retrospectively assessed using Proclarix™ and BCN-RCs 1 and 2. Six RSPs were compared with those recommended by the EAU that, stratifying men from MRI, avoided 16.7% of prostate biopsies with a prostate imaging–reporting and data system score of <3, with 2.6% of csPCa cases remaining undetected. The most effective RSP avoided mpMRI exams in men with a serum PSA level of >10 ng/mL and suspicious DRE, following stratifications from BCN-RC 1, mpMRI, and Proclarix™. The demand for mpMRI decreased by 19.9%, prostate biopsies by 19.8%, and over-detection of iPCa by 22.7%, while 2.6% of csPCa remained undetected as in the recommended RSP. Cost-effectiveness remained when the Proclarix™ price was assumed to be below EUR 200. info:eu-repo/grantAgreement/ES/ISCIII/PI20/01666 info:eu-repo/semantics/openAccess by https://creativecommons.org/licenses/by/4.0/deed.es 0.863 2024 Medicine (miscellaneous) 2024 Q2 6.0 2024 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Borque-Fernando, Ángel Universidad de Zaragoza (orcid)0000-0003-0178-4567 Esteban, Luis M. (orcid)0000-0002-3007-302X Celma, Ana Campistol, Miriam Miró, Berta Méndez, Olga Trilla, Enrique 1013 817 Universidad de Zaragoza Dpto. Cirugía Área Urología 14, 2 (2024), 130 [15 pp.] J. pers. med. Journal of Personalized Medicine 2075-4426 3129087 http://zaguan.unizar.es/record/131276/files/texto_completo.pdf Versión publicada 2758143 http://zaguan.unizar.es/record/131276/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:131276 articulos driver 2026-01-12-12:35:16 ARTICLE