Prostatic-specific antigen density behavior according to multiparametric magnetic resonance imaging result

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer (CaP) diagnosis relies on various indicators, including prostate-specific antigen density (PSAD) and multiparametric magnetic resonance imaging (mpMRI).
• The Prostate Imaging Reporting and Data System (PIRADSv.2) score categorizes MRI findings, aiding in risk stratification.
• Understanding the interplay between PSAD and PIRADSv.2 is crucial for optimizing diagnostic strategies.

Purpose of the Study:

• To analyze the relationship between prostate-specific antigen density (PSAD) and Prostate Imaging Reporting and Data System (PIRADSv.2) scores.
• To determine the utility of PSAD in predicting significant prostate cancer (sCaP) across different PIRADSv.2 categories.
• To evaluate the combined diagnostic performance of mpMRI and PSAD for prostate cancer detection.

Main Methods:

• A cohort of 952 men with elevated PSA or abnormal DRE underwent transrectal ultrasound-guided prostate biopsy (PB).
• Men with prior 5-α-reductase inhibitor use or prostate cancer history were excluded; 768 men underwent 3-T mpMRI.
• Significant CaP (sCaP) was defined by International Society of Uropathologist grade or tumor length; PSAD was analyzed against PIRADSv.2 scores and biopsy outcomes.

Main Results:

• Overall CaP detection was 41.7%, with sCaP in 37.4%. sCaP detection rates increased significantly with PIRADSv.2 score (4.3% for <3 to 78.5% for 5).
• PSAD was an independent predictor of sCaP (OR 1.971) and improved mpMRI performance (AUC increased from 0.830 to 0.869).
• PSAD increased with PIRADSv.2 score, but its efficacy in predicting sCaP decreased for PIRADSv.2 scores of 3 and above.

Conclusions:

• The predictive value of PSAD for significant prostate cancer diminishes as PIRADSv.2 scores increase.
• Factors beyond mpMRI and PSAD, such as age and family history, also independently predict sCaP.
• Developing nomograms integrating these predictors is recommended for personalized prostate biopsy decisions.