The value of prostate specific antigen density in the detection of prostate cancer by the multi-parametric MRI

Abstract

Objective To evaluate whether prostate specific antigen density(PSAD) could improve the multi-parametric MRI detection of prostate cancer. Methods A total of 110 men from Beijing United Family Hospital and clinics undergoing systematic biopsy + MRI-targeted biopsy from April 2013 to March 2019 were included in the study. The median age was 63.5 years (43.0-84.0 years), median prostate specific antigen (PSA)was 7.0 ng/ml (0.7-43.4 ng/ml), median PSAD was 0.16ng/ml2(0.03-1.15 ng/ml2), median PI-RADS was 3.5(2.0-5.0). Results A total of 45 cases of prostate cancer were detected, including 32 cases of clinically significant prostate cancer. Systematic biopsy detected 36 cases of prostate cancer, including 23 cases of clinically significant prostate cancer; MRI-targeted biopsy detected 38 cases of prostate cancer, including 27 cases of clinically significant prostate cancer. For MRI-targeted biopsy, the area under curve (AUC) of PSAD, PI-RADS and PSAD+ PI-RADS were 0.807, 0.757, 0.841 for prostate cancer and were 0.806, 0.78, 0.862 for clinically significant prostate cancer. PSAD+ PI-RADS achieved significantly superior AUC compared with PI-RADS alone for both prostate cancer detection (P=0.0034) and clinically significant prostate cancer detection(P=0.0128). For systematic biopsy + MRI-targeted biopsy, the AUC of PSAD, PI-RADS and PSAD+ PI-RADS were 0.765, 0.791, 0.857 for prostate cancer and were 0.790, 0.785, 0.853 for clinically significant prostate cancer. PSAD+ PI-RADS showed significantly higher AUC compared with PI-RADS for prostate cancer detection (P=0.0042) and clinically significant prostate cancer detection(P=0.0170). Conclusions For prostate biopsy naive men, PSAD+ PI-RADS showed significantly higher predictive value than PI-RADS alone for prostate cancer and clinically significant prostate cancer detection either by MRI-targeted biopsy or by systematic biopsy+ MRI-targeted biopsy. Key words: Prostatic neoplasms; Targeted biopsy; Magnetic resonance imaging; Prostate specific antigen density; Diagnosis