PI-RADSv2.1 combined with PSA density for optimizing prostate biopsy decisions: a retrospective analysis

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer diagnosis relies on accurate risk stratification for timely intervention.
• The Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) and prostate-specific antigen density (PSAD) are key metrics in evaluating prostate cancer risk.
• Optimizing prostate biopsy indications is crucial to enhance diagnostic yield and minimize patient burden.

Purpose of the Study:

• To evaluate the combined application of PI-RADS v2.1 and PSAD in guiding prostate biopsies.
• To improve the detection rate of clinically significant prostate cancer (csPCa).
• To reduce the number of unnecessary prostate biopsies.

Main Methods:

• Retrospective analysis of 462 patients undergoing prostate biopsy.
• Univariate and multivariate logistic regression to identify independent risk factors for csPCa.
• Receiver operating characteristic (ROC) curve analysis to assess diagnostic performance, including sensitivity, specificity, and predictive values.

Main Results:

• Both PI-RADS v2.1 score and PSAD were identified as independent risk factors for csPCa.
• The combined PI-RADS v2.1 and PSAD approach demonstrated excellent diagnostic performance (AUC = 0.966), with 92.4% sensitivity and 91.6% specificity.
• Specific thresholds for PI-RADS v2.1 (≥4) and PSAD (≥0.30 ng/(mL·cm³)) were established for csPCa diagnosis, with safe biopsy avoidance noted in lower-risk groups.

Conclusions:

• Combining PI-RADS v2.1 and PSAD provides a robust framework for prostate biopsy indications.
• This integrated approach can safely avoid biopsies in a significant proportion of patients (up to 40% in the study cohort).
• The study recommends specific criteria based on PI-RADS v2.1 scores and PSAD levels to guide biopsy decisions, optimizing patient management.