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Published on: March 21, 2025
Incremental diagnostic value of MRI PI-RADS classification combined with PSA density for prostate cancer
Xinbo Sun1, Yongwei Chen1, Shengtao Ling1
1Department of Urology, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
Objective:
To investigate the incremental diagnostic value of magnetic resonance imaging Prostate Imaging Reporting and Data System (PI-RADS) score combined with prostate-specific antigen density (PSAD) for prostate cancer (PCa), and to evaluate the clinical implications of different combined strategies.
Methods:
A total of 187 patients who underwent prostate MRI and had pathological results were retrospectively included, including 117 with PCa and 70 with benign prostatic hyperplasia. Univariate and multivariate logistic regression analyses were performed. A PI-RADS-only model, a log(PSAD)-only model, a combined model, and an adjusted model were constructed. Receiver operating characteristic curves and DeLong tests were used to evaluate diagnostic performance.
Results:
Age, log(tPSA), f/t ratio, log(PSAD), and PI-RADS score were all significantly associated with PCa diagnosis (all P < 0.001). After adjustment for age and f/t ratio, PI-RADS score (OR = 4.059, 95% CI: 2.570-6.412, P < 0.001) and log(PSAD) (OR = 2.743, 95% CI: 1.553-4.845, P < 0.001) remained independent factors. The combined model showed a higher AUC than the PI-RADS-only and log(PSAD)-only models.
Conclusion:
PI-RADS combined with PSAD improves diagnostic discrimination for PCa and may support different clinical strategies requiring higher specificity or sensitivity.
