Evaluation of Predictive Factors for Prostate Cancer Detection in PI-RADS 2 Lesions

To evaluate clinical, biochemical, and hematological parameters as predictors of prostate cancer (PCa) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 2 lesions.

A total of 955 patients underwent multiparametric magnetic resonance imaging (mpMRI) during the study period, of whom 268 had PI-RADS 2 lesions. Among these, 147 patients with histopathological diagnoses, including 122 benign and 25 malignant cases, were included. Clinical, biochemical, and hematological parameters were compared between groups using appropriate statistical tests. Receiver operating characteristic (ROC) curve analyses were performed to evaluate diagnostic performance.

Prostate-specific antigen (PSA) density (P = .044), neutrophil count (P = .019), monocyte count (P = .021), neutrophil-to-platelet ratio (NPR; P = .016), and monocyte-to-platelet ratio (MPR; P = .019) differed significantly between the malignant and benign groups. Compared with the benign group, neutrophil count, monocyte count, NPR, and MPR were lower, whereas PSA density was higher in patients with PCa. ROC analyses demonstrated moderate discriminatory performance for PSA density (area under the curve [AUC], 0.654; 95% confidence interval [CI], 0.561-0.739; P = .007), monocyte count (AUC, 0.655; 95% CI, 0.546-0.754; P = .011), MPR (AUC, 0.657; 95% CI, 0.547-0.755; P = .037), neutrophil count (AUC, 0.635; 95% CI, 0.523-0.737; P = .046), and NPR (AUC, 0.644; 95% CI, 0.536-0.743; P = .055).

PSA density demonstrated moderate discriminatory performance for detecting PCa in biopsied patients with PI-RADS 2 lesions. Although several hematological indices also showed moderate discriminatory performance, their clinical utility remains limited. Larger prospective studies are required to validate these findings before clinical implementation.