Diagnostic efficacy of PI-RADS v2.1 in combination with prostate-specific antigen density for clinically significant prostate cancer
Objective To investigate the diagnostic value of prostate reporting and data system(PI-RADS v2.1)combined with prostate-specific antigen density(PSAD)for clinically significant prostate cancer(csPCa).Methods Clinical data of 522 patients,who underwent prostate MRI examination and biopsy between February 2019 and February 2023,were collected.The patients'age,laboratory indicators(tPSA,f/tPSA,PSAD),PV,ADCmean,and PI-RADS v2.1 score were reviewed.The patients were divided into PCa group and BPH group based on puncture biopsy or surgical results;according to the pathological results,they were further divided into csPCa group and non csPCa group.By using univariate and multivariate logistic regression and receiver operating characteristic(ROC)curve analysis,the diagnostic efficacy of different predictive factors was compared.Based on the cutoff points for detecting PCa and csPCa and identifying outliers using PSAD,the patients were divided into four PSAD subgroups to further analyze the clinical significance of different PI-RADS v2.1 scores and PSAD levels in diagnosing csPCa.Results Univariate analysis revealed statistically significant differences in patient age,tPSA,PV,PSAD,ADCmean,and PI-RADS between the PCa and BPH groups,as well as between the csPCa and non csPCa groups(P＜0.05).Multivariate regression analysis demonstrated that PI-RADS v2.1 score and PSAD were risk factors for csPCa(P＜0.001).The AUC were 0.895 and 0.936,when combining the two indicators in diagnosing PCa and csPCa.Further analysis based on the determined PSAD cutoff values(0.24,0.64)and the acceptance threshold(0.15)for PCa and csPCa revealed that there was a statistically significant difference(P＜0.05)between the PSAD≥0.15 ng/(mL·cm3)or PI-RADS v2.1 score≥4 group and the group with PI-RADS v2.1 score≤2 or PI-RADS v2.1 score=3 and PSAD＜0.15 ng/(mL·cm3).Conclusion The combination of PI-RADS v2.1 score and PSAD has better diagnostic efficacy for detecting csPCa.Patients with PI-RADS v2.1 score≤2 or PI-RADS v2.1 score=3 and PSAD＜0.15 ng/(mL·cm3)have a lower risk of developing csPCa.
prostate imaging reporting and data systemmultiparametric magnetic resonance imagingprostate-specific antigen densitydiagnosis
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