A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

Abstract

The gray-zone prostate-specific antigen (PSA) range is accepted to be 4-10 ng/ml and is considered to vary according to age. We aimed to investigate whether fusion prostate biopsy (FPB), which has been reported to have relatively higher cancer detection rates, has an effect on gray-zone PSA cutoff value. Material and methods This retrospective study included patients that underwent standard prostate biopsy (SPB) or multiparametric magnetic resonance imaging (MpMRI)-guided FPB (SPB+ targeted biopsy). All the patients included in the study were detected with a Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesion on MpMRI (the FPB group only). The demographics, clinical characteristics, and histopathological diagnoses were recorded for each patient. Results A total of 1,628 patients comprising 1,208 patients in the SPB group and 420 patients in the FPB group were included in the study. The mean PSA level was 9.75±6.68 ng/ml in the FBP group and 10.46±6.46 ng/ml in the SPB group (p=0.053). Prostate cancer (PCa) detection rate was significantly higher in the FPB group as compared to the SPB group (42.4% vs. 36.4%). The PSA cutoff value for PCa was 9.75 ng/ml (sensitivity and specificity, 81%) in the SPB group and was 7.55 ng/ml (sensitivity and specificity, 81% and 84%, respectively) in the FPB group. In the FPB group, the cancer detection rate among the patients with a PSA level of 7.55-10.00 ng/ml was 56.1%. Conclusion The results indicated that the introduction of FPB into clinical practice, which has relatively higher cancer detection rates, has further lowered the upper limit for gray-zone PSA.

Prebiopsy bpMRI and hematological parameter-based risk scoring model for predicting outcomes in biopsy-naive men with PSA 4–20 ng/mL

“…The incidence of PCa in China is lower than that in Western countries, and when the PSA level was 4 to 20 ng/mL, the detection rate of PCa is 25% or less 3 . In addition, studies have shown that different prostate biopsy methods may change the PSA gray zone range 24 . Therefore, some researchers believe that the "gray zone" of PSA in Asian men should be higher than the traditional "gray zone" 25 , 26 .…”

Patients With “Gray Zone” PSA Levels: Application of Prostate MRI and MRS in the Diagnosis of Prostate Cancer

“…Table 1 shows the basic characteristics of 23 articles included in this review. The study sample size ranged from 26 16 to 2426 17 patients having the age ranging from 34 to 91 years with the reported mean (median) age ranging from 61.5 18 to 75 19 years. In terms of study design, 6 of the 23 (26.1%) studies 16,[20][21][22][23][24] were prospective and 15 of the 23 (65.2%), 17,19,[25][26][27][28][29][30][31][32][33][35][36][37] were retrospective.…”