Precision in prostate cancer detection: integrating prostate-specific antigen density (PSAD) and the Prostate Imaging Reporting and Data System (PI-RADS) to provide additional risk stratification for a more accurate diagnostic decision

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer diagnosis in biopsy-naïve patients requires accurate risk stratification.
• Multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System (PI-RADS) is crucial.
• Prostate-specific antigen density (PSAD) offers additional predictive information.

Purpose of the Study:

• To evaluate the combined diagnostic performance of PSAD and PI-RADS.
• To enhance risk stratification for clinically significant prostate cancer (csPCa) in biopsy-naïve men.
• To assess the added value of integrating PSAD with PI-RADS categories.

Main Methods:

• Prospective study of 339 biopsy-naïve patients with suspected prostate cancer.
• Utilized multiparametric MRI, PI-RADS scoring, and PSAD measurements.
• Employed logistic regression and ROC analysis to assess predictive performance.

Main Results:

• Clinically significant prostate cancer (csPCa) rates increased with higher PSAD levels.
• Both PI-RADS and PSAD independently predicted csPCa.
• Combined PI-RADS and PSAD model (AUC 0.756) outperformed individual predictors (PSA AUC 0.627, PI-RADS AUC 0.689, PSAD AUC 0.708).

Conclusions:

• Integrating PSAD and PI-RADS improves diagnostic accuracy for csPCa in biopsy-naïve men.
• This combined strategy offers enhanced risk stratification, particularly for PI-RADS 3 lesions.
• The findings support a more precise diagnostic decision-making process.