Unlocking Precision Enhancing Prostate Cancer Detection and Reducing Unnecessary Biopsies with Combined Prostate-Specific Antigen Density and PI-RADS Score

Nurullah Hamidi ¹, Tuncel Uzel ¹, Aykut Demirci ¹

⁰Department of Urology, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkiye.

Journal of the College of Physicians and Surgeons--Pakistan : Jcpsp +

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October 16, 2024

View abstract on PubMed

Summary

Combining prostate-specific antigen density (PSAD) and PI-RADS scores helps identify clinically significant prostate cancer (csPCa). Low PSAD and PI-RADS scores indicate a low csPCa detection rate, potentially avoiding unnecessary biopsies.

Area Of Science

Urology
Oncology
Radiology

Background

Prostate cancer diagnosis relies on various markers including Gleason score, PI-RADS, prostate-specific antigen (PSA), and prostate-specific antigen density (PSAD).
Multiparametric magnetic resonance imaging (mpMRI) and PSAD are crucial in assessing the likelihood of clinically significant prostate cancer (csPCa).

Purpose Of The Study

To determine the clinically significant prostate cancer (csPCa) detection rate by integrating prostate-specific antigen density (PSAD) and Prostate Imaging-Reporting and Data System (PI-RADS) scores.
To evaluate the utility of combining PSAD and PI-RADS for optimizing prostate biopsy decisions.

Main Methods

A descriptive study was conducted from January 2018 to April 2023.
Patients undergoing prostate biopsies post-mpMRI were analyzed, with PI-RADS 4-5 lesions classified as MR positive.
csPCa detection rates were assessed by stratifying patients based on PSAD cut-off values and PI-RADS scores.

Main Results

A PSAD cut-off of 0.165 ng/mL/mL demonstrated 80% sensitivity and 72% specificity for csPCa detection (AUC = 0.81).
Patients with PI-RADS 1-3 scores and PSAD <0.165 ng/mL/mL had a low csPCa detection rate (3%).
Conversely, patients with PI-RADS 4-5 scores and PSAD ≥0.165 ng/mL/mL showed a high csPCa detection rate (50.5%).

Conclusions

Low PSAD values combined with PI-RADS 1-3 scores are associated with a low probability of clinically significant prostate cancer.
This combined approach may help in avoiding unnecessary prostate biopsies in select patient groups.