Predictors of Clinically Significant Prostate Cancer: A Comparative Study of PSA, PSA Density, and MRI Parameters

Abstract

Introduction:The purpose of this study was to compare prostate-specific antigen (PSA), PSA density (PSAd), the prostate imaging-reporting and data system (PI-RADS) score, and lesion dimension (four parameters) in clinically significant prostate cancer (PCa) detection.Methods:This study included 154 patients who underwent multi-parametric prostate magnetic resonance imaging (mpMRI) and 12 quadrant systematic prostate biopsy between 01/2018 and 03/2019. Two radiologists used the PI-RADS version 2.1 to describe the MRI findings by consensus. A Gleason score ≥3+4 was assessed as clinically significant PCa. Areas under the curve (AUC) were calculated using receiver operating characteristics. Youden’s index was used to determine ideal cutoffs. DeLong’s test was used to evaluate statistically significant differences between the four parameters.Results:The median age was 66 (±6.9) in this cohort. The median PSA level was 7.8 ng/dL (±18.4, 1.6-109.3), the median PSAd was 0.146 ng/mL/cm3, and the median lesion dimension was 12 mm. In MRI, the number of cases with the PI-RADS scores from 1 to 5 were 34, 6, 11, 38, and 65, respectively. In terms of pathology, there was no tumor in 44 patients’ samples, while insignificant cancer and clinically significant PCa were seen in 33 and 77, respectively. The AUC values of PSA, PSAd, PI-RADS score, and lesion dimension were 0.684, 0.731, 0.856, and 0.858, respectively. The optimal cutoffs were ≥10 ng/mL for PSA, ≥0.22 ng/mL/cm3 for PSAd, ≥4 for the PI-RADS score and ≥10 mm for lesion dimension. DeLong’s tests showed that the PI-RADS score and lesion dimension were significantly superior to PSA and PSAd. There was no significant difference between the PI-RADS score and lesion dimension.Conclusion:The PI-RADS score and lesion dimension had higher accuracy than PSA and PSAd in clinically significant PCa detection. Lesions ≥10 mm were associated with the risk of clinically significant PCa, and this should be considered in reporting.

Keywords

• multiparametric prostate mri
• pi-rads category
• prostate-specific antigen
• prostate biopsy
• prostate cancer