PI-RADS-stratified MRI-based PSA Density for Predicting Adverse Pathology after Robotic-assisted Laparoscopic Radical...

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Multiparametric MRI (mpMRI) and prostate-specific antigen density (PSAD) are vital for risk stratifying localized prostate cancer.
• The optimal PSAD threshold for predicting adverse pathology and long-term outcomes post-radical prostatectomy remains unclear.

Purpose of the Study:

• To assess the prognostic value of MRI-based PSAD in predicting adverse pathology and oncologic outcomes.
• To determine optimal PSAD cutoffs for men undergoing robotic-assisted laparoscopic radical prostatectomy (RALP).

Main Methods:

• Analysis of a prospective cohort of 788 patients undergoing RALP (2006-2023) with preoperative mpMRI.
• Primary endpoint: adverse pathology (≥pT3, Grade Group ≥4, SVI, nodal positivity, or PSM).
• Secondary outcomes: biochemical recurrence-free survival (BRFS).

Main Results:

• MRI-based PSAD independently predicted adverse pathology (OR 15.633), SVI (OR 2.614), PSM (OR 3.650), and PSA persistence (OR 4.463).
• PSAD ≥0.10 ng/ml/cm³ showed maximum net benefit for PI-RADS ≥3 lesions.
• PSAD ≥0.15 ng/ml/cm³ demonstrated higher specificity and better performance for PI-RADS ≤2 lesions, correlating with worse BRFS.

Conclusions:

• MRI-based PSAD is a significant independent predictor of adverse pathology and outcomes after RALP.
• A PSAD threshold of 0.15 ng/ml/cm³ is recommended for PI-RADS ≤2 lesions.
• A PSAD threshold of 0.10 ng/ml/cm³ is suggested for PI-RADS ≥3 lesions.