The Role of PSA Density among PI-RADS v2.1 Categories to Avoid an Unnecessary Transition Zone Biopsy in Patients with PSA 4-20 ng/mL

Abstract

Objective. To evaluate the role of prostate-specific antigen density (PSAD) in different Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) categories to avoid an unnecessary biopsy in transition zone (TZ) patients with PSA ranging from 4 to 20 ng/mL. Materials and Methods. In this retrospective and single-center study, 333 biopsy-naïve patients with TZ lesions who underwent biparametric magnetic resonance imaging (bp-MRI) were analyzed from January 2016 to March 2020. Multivariate logistic regression analyses were performed to determine independent predictors of clinically significant prostate cancer (cs-PCa). The receiver operating characteristic (ROC) curve was used to compare diagnostic performance. Results. PI-RADS v2.1 and PSAD were the independent predictors for TZ cs-PCa in patients with PSA 4-20 ng/mL. 0.9% (2/213), 10.0% (7/70), and 48.0% (24/50) of PI-RADS v2.1 score 1-2, 3, and 4-5 had TZ cs-PCa. However, for patients with PI-RADS v2.1 score 1-2, there were no obvious changes in the detection of TZ cs-PCa (0.8% (1/129), 1.3% (1/75), and 0.0% (0/9)) combining with different PSAD stratification ( PSAD < 0.15 , 0.15-0.29, and ≥0.30 ng/mL/mL). For patients with PI-RADS v2.1 score ≥ 3 , the TZ cs-PCa detection rate significantly varied according to different PSAD stratification. A PI-RADS v2.1 score 3 and PSAD < 0.15 and 0.15-0.29 ng/mL/mL had 8.6% (3/35) and 3.7% (1/27) of TZ cs-PCa, while a PI-RADS v2.1 score 3 and PSAD ≥ 0.30 ng / mL / mL had a higher TZ cs-PCa detection rate (37.5% (3/8)). A PI-RADS v2.1 score 4-5 and PSAD <0.15 ng/mL/mL had no cs-PCa (0.0% (0/9)). In contrast, a PI-RADS v2.1 score 4-5 and PSAD 0.15-0.29 and ≥0.30 ng/mL/mL had the highest cs-PCa detection rate (50.0% (10/20), 66.7% (14/21)). It showed the highest AUC in the combination of PI-RADS v2.1 and PSAD (0.910), which was significantly higher than PI-RADS v2.1 (0.889, P = 0.039 ) or PSAD (0.803, P < 0.001 ). Conclusions. For TZ patients with PSA 4-20 ng/mL, PI-RADS v2.1 score ≤ 2 can avoid an unnecessary biopsy regardless of PSAD. PI-RADS v2.1 score ≥ 3 may avoid an unnecessary biopsy after combining with PSAD. PI-RADS v2.1 combined with PSAD could significantly improve diagnostic performance.

MRI-Based Radiomics Nomogram for Predicting Prostate Cancer with Gray-Zone Prostate-Specific Antigen Levels to Reduce Unnecessary Biopsies

“…Some previous studies have used PI-RADS for PCa screening [ 26 , 27 ]. Wang et al [ 26 ] showed that for TZ patients with PSA levels of 4–20 ng/mL, the PI-RADS V2.1 score detected PCA with an AUC of 0.889.…”

“…Some previous studies have used PI-RADS for PCa screening [ 26 , 27 ]. Wang et al [ 26 ] showed that for TZ patients with PSA levels of 4–20 ng/mL, the PI-RADS V2.1 score detected PCA with an AUC of 0.889. Sun et al [ 27 ] incorporated risk factors, including the PSA level and PI-RADS V2 score into a nomogram, which showed better PCa prediction performance (AUC = 0.876) than PI-RADS V2 only.…”

Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy

“…We selected different thresholds of mPSAD to obtain similar performance in our series of PI-RADS 3 than that of Görtz et al [22,81]. The use of appropriate thresholds in different populations has been previously described for mPSAD [19][20][21][82][83][84][85][86][87][88][89][90][91][92][93][94][95].…”

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

“…For example, no significant difference in PCa detection rates has been reported for PSA between 4 ng/mL and 10 ng/mL (11.8%–20.5%) and 10–20 ng/mL (20.5%–25.0%). Therefore, a study by Wang et al 56 included patients with PSA within 4–20 ng/mL. Second, differences in the clinically significant predictors across studies lead to diversity in model building.…”