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Published on: March 21, 2025
Early Differentiation of Prostatic Intraepithelial Neoplasia via Multiparametric MRI Combined with PSA-derived
Guannan Zou1, Jingyan Liu2, Huanhuan Zhong1
1Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China.
Background:
Prostatic intraepithelial neoplasia (PIN) is a precancerous lesion. Early differentiation of PIN is very important for the prevention of PIN occurrence and malignization.
Objectives:
To differentiate prostatic intraepithelial neoplasia (PIN) via multiparametric MRI (mpMRI) combined with prostate-specific antigen (PSA)-derived parameters.
Materials And Methods:
From March 2022 to June 2024, 47 males, including 39 with benign prostatic hyperplasia (BPH) and 8 with PIN, were enrolled. All patients underwent prostatic mpMRI. The apparent diffusion coefficients (ADC), Ktrans, kep, ve, initial area under curve (iAUC), and PI-RADS score were derived from mpMRI. The parameters between PIN and BPH were compared via Student's t test or Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy.
Results:
The ADC value of PIN was significantly greater than that of BPH (0.912 vs. 0.806 × 10-3 mm2/s, P=0.035). The tPSA, fPSA, and PSA density (PSAD) of PIN were significantly lower than those of BPH (6.715 vs. 11.640 ng/mL, P=0.008; 1.427 vs. 2.109 ng/mL, P=0.042; 0.095 vs. 0.158 ng/mL2, P=0.010; respectively). The AUC of tPSA was slightly greater than those of PSAD, ADC, and fPSA (0.801 > 0.792 > 0.724 > 0.716) in differentiating PIN from BPH. When the tPSA was ≤ 8.47 ng/mL, the highest sensitivity (87.5%) and negative predictive value (96.8%) were observed in differentiating PIN from BPH. When the ADC and PSA-derived parameters were combined, the highest specificity (94.9%) was acquired in differentiating PIN from BPH. ADC (OR=0.120, P = 0.043) and PSAD (OR=0.056, P = 0.005) were independent risk predictors for differentiating PIN from BPH.
Discussion:
ADC derived from mpMRI combined with PSA-derived parameters exhibit enormous potential for differentiating PIN from BPH.
Conclusions:
ADC and PSA-derived parameters can distinguish PIN from BPH. The ADC value combined with tPSA can achieve the highest diagnostic efficiency in detecting PIN. The ADC may function as a potential biomarker to differentiate precancerous lesions of the prostate.
Insights
Multiparametric MRI (mpMRI) apparent diffusion coefficient (ADC) values and prostate-specific antigen (PSA)-derived parameters can differentiate prostatic intraepithelial neoplasia (PIN) from benign prostatic hyperplasia (BPH). Combining ADC with total PSA (tPSA) offers the highest diagnostic efficiency for detecting PIN.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Prostatic intraepithelial neoplasia (PIN) is a precancerous prostate lesion.
- Early differentiation of PIN is crucial for preventing its progression and malignancy.
Purpose of the Study:
- To differentiate PIN from benign prostatic hyperplasia (BPH) using multiparametric MRI (mpMRI) and prostate-specific antigen (PSA)-derived parameters.
- To evaluate the diagnostic efficacy of combining mpMRI and PSA-derived parameters for PIN detection.
Main Methods:
- 47 male patients (39 BPH, 8 PIN) underwent mpMRI.
- Apparent diffusion coefficients (ADC) and PSA-derived parameters (tPSA, fPSA, PSAD) were analyzed.
- Statistical tests (t-test, Mann-Whitney U) and ROC curves were used for comparison and efficacy evaluation.
Main Results:
- PIN showed significantly higher ADC values (0.912 vs. 0.806 × 10-3 mm2/s) and lower tPSA, fPSA, and PSAD compared to BPH.
- Total PSA (tPSA) demonstrated the highest AUC (0.801) for differentiation.
- Combining ADC and PSA-derived parameters achieved the highest specificity (94.9%).
- ADC and PSAD were identified as independent risk predictors.
Conclusions:
- mpMRI-derived ADC combined with PSA-derived parameters shows significant potential for differentiating PIN from BPH.
- The combination of ADC and tPSA provides the highest diagnostic efficiency for detecting PIN.
- ADC may serve as a valuable biomarker for precancerous prostate lesions.
