Efficacy of plasma atherogenic index in predicting malignancy in the presence of Prostate Imaging–Reporting and Data System 3 (PI-RADS 3) prostate lesions

Abstract

Purpose:The prevalence of the clinically signi cant prostate cancer (csPCa) among the Prostate Imaging-Reporting and Data System (PI-RADS) 3 cases is estimated to be 16%, which suggests that the indication for biopsy by the combined method may be further re ned. Plasma atherogenic index (PAI) was shown to be positively correlated with the presence of malignity in patients with suspicious ndings for renal cell cancer and colon cancer in reported studies. In this study, we aimed to evaluate whether there is an association with the presence of malignity in a patient with magnetic resonance imaging (MRI)-visible lesions, classi ed as PI-RADS 3 and PAI.Methods:This retrospective study reviewed the data of 139 patients who underwent transrectal ultrasonography (TRUS)-guided systematic and cognitive fusion prostate biopsy for PI-RADS 3 lesions in multiparametric MRI (mpMRI). The patients were divided to two groups as malign (n=33) and benign (n=106) according to pathology results. The association between age, body mass index [BMI], comorbidities, smoking status, prostate speci c antigen [PSA], PSA density [PSAD], free/total PSA, prostate weight, lesion diameter, triglyceride value, high density lipoprotein (HDL)-Cholesterol value, PAI value data and presence of malignity were investigated by descriptive and multivariate analysis. Receiver operating characteristic (ROC) curves were created to evaluate the predictive role of the parameters and cut-off values were found.Results: PSA, PSAD, lesion diameter and PAI value were statistically signi cantly higher in the malignant group compared to the benign group, the free/total PSA ratio was lower (p<0.001, p<0.001, p=0.001, p=0.025, p<0.001, respectively). In multivariate logistic regression analysis, PSA > 9.9 ng/ml (OR=4.579; 95% Cl=1.455-14.413; p=0.009), free/total PSA < 12.1% (OR=5.851; 95% CI=1.752-9.442; p <0.001), lesion diameter > 13.5 mm (OR=5.695; 95% CI=1. 694-19.146; p=0.005) and PAI > 0.13 (OR=3.821; 95% CI=1.208-12084; p=0.022) were identi ed as independent risk factors for presence of prostate malignancy.Conclusion: PAI demonstrated a strong association with PCa and additionally proved to be predictive in the discrimination between malignity positive and negative PI-RADS 3 lesions and it may be used as a predictive parameter in the decision of biopsy in patients with PI-RADS 3 lesions.