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Updated: Dec 31, 2025
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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
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Combining Prostate-Specific Antigen Parameters With Prostate Imaging Reporting and Data System Score Version 2.0 to
Sasanka Kumar Baruah1, Nabajeet Das1, Saumar Jyoti Baruah1
1Department of Urology, Gauhati Medical College and Hospital, Guwahati, India.
World Journal of Oncology
|January 11, 2020
Summary
This study shows that Prostate Imaging Reporting and Data System (PIRADS) score, combined with PSA density (PSAD) and free PSA%, can accurately predict clinically significant prostate cancer (CSPCa). These non-invasive markers help reduce unnecessary biopsies in men with borderline PSA levels.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Non-invasive tests are needed to predict the absence of prostate cancer (PCa) or clinically significant PCa (CSPCa).
- This is crucial for reducing unnecessary biopsies in patients with gray zone prostate-specific antigen (PSA) levels (4-10 ng/mL).
- The diagnostic performance of free PSA%, PSA density (PSAD), and Prostate Imaging Reporting and Data System (PIRADS) score (version 2.0) was evaluated.
Purpose of the Study:
- To evaluate the diagnostic performance of free PSA%, PSAD, and PIRADS score alone and in combination.
- To predict CSPCa in patients with serum PSA levels between 4 and 10 ng/mL.
- To assess the utility of these markers in reducing unnecessary prostate biopsies.
Main Methods:
- A prospective study included 104 consecutive patients with lower urinary tract symptoms (LUTS) and PSA levels between 4-10 ng/mL.
- Multi-parametric magnetic resonance imaging (mp-MRI) was used to calculate PIRADS scores before transrectal ultrasound (TRUS) biopsy.
- Statistical analysis correlated PIRADS score, PSAD, free PSA%, and CSPCa presence.
Main Results:
- Patients with CSPCa had significantly higher median age, PSA, and PSAD, and lower prostate volume and free PSA% compared to non-CSPCa patients.
- A higher proportion of CSPCa patients showed a positive PIRADS test (86.4% vs. 53.3%).
- Cut-off values for PSAD and free PSA% were 0.12 ng/mL² and 25%. Age and PSAD were significant predictors of CSPCa. Criteria 2, 3, and 4 of PIRADS showed higher specificity and accuracy (up to 85.58%) than criterion 1.
Conclusions:
- PIRADS score, especially criteria 2, 3, and 4, demonstrates higher diagnostic performance for predicting CSPCa.
- The accuracy of mp-MRI in predicting CSPCa can be significantly increased by incorporating PSAD and free PSA%.
- These combined non-invasive markers show promise in improving CSPCa detection and reducing unnecessary biopsies.
Keywords:
Clinically significant prostate cancerFree PSA%PIRADS scorePSA densityProstate biopsymp-MRI
