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PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer

Prostate Cancer and Prostatic Diseases volume 26, pages 347–352 (2023)Cite this article

Subjects

Abstract

Background

While prostate multiparametric-magnetic resonance imaging (MP-MRI) has improved the diagnosis of clinically significant prostate cancer (CSPC), the complementary use of prostate-specific antigen (PSA) levels to risk-stratify for CSPC requires further study. The objective of this project was to determine if prostate MP-MRI and PSA can provide complementary insights into CSPC risk stratification.

Methods

In an IRB-approved study, pathologic outcomes from patients who underwent MR/US fusion-targeted prostate biopsy were stratified by various parameters including PSA, PSA density (PSAD), age, race, and PI-RADS v2 score. CSPC was defined as a Gleason score ≥7. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals (CI). P values were reported as two-sided with p < 0.05 considered statistically significant. ROC curves were generated for assessing the predictive value of tests and sensitivity + specificity optimization was performed to determine optimal testing cutoffs.

Results

A total of 327 patients with 709 lesions total were analyzed. PSAD and PI-RADS scores provided complementary predictive value for diagnosis of CSPC (AUC PSAD: 0.67, PI-RADS: 0.72, combined: 0.78, p < 0.001). When controlling for PI-RADS score, age, and race, multivariate analysis showed that PSAD was independently associated with CSPC (OR 1.03 per 0.01 PSAD increase, 95% CI 1.02–105, p < 0.001). The optimal cutoff of PSAD ≥ 0.1 ng/ml/cc shows that a high versus low PSAD was roughly equivalent to an increase in 1 in PI-RADS score for the presence of CSPC (4% of PI-RADS ≤3 PSAD low, 6% of PI-RADS 3 PSAD high vs. 5% of PI-RADS 4 PSAD low, 22% of PI-RADS 4 PSAD high vs. 29% of PI-RADS 5 PSAD low, 46% of PI-RADS 5 PSAD high were found to have CSPC).

Conclusions

PSAD with a cutoff of 0.1 ng/ml/cc appears to be a useful marker that can stratify the risk of CSPC in a complementary manner to prostate MP-MRI.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA

    James W. Frisbie, Alexa J. Van Besien, Adrianna Lee, Linhan Xu, Shu Wang, M. Adil Afzal, Michael J. Naslund & Mohummad Minhaj Siddiqui

  2. Department of Urology, Yale School of Medicine, New Haven, CT, USA

    Ankur Choksi

  3. Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA

    Barton Lane, Jade Wong & Amelia Wnorowski

  4. Veterans Affairs Maryland Healthcare System, Baltimore, MD, USA

    Mohummad Minhaj Siddiqui

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  1. James W. Frisbie
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Contributions

AJVB, AL, LX, SW, and JWF were responsible for adding and maintaining the list of patient parameters in the system database. AW was responsible for the review of PI-RADS lesions. MJN and MMS were responsible for conducting biopsies. JW was responsible for manuscript creation. JWF, AC, and SW were responsible for data analysis. All authors were involved in the revision of the manuscript.

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Correspondence to Mohummad Minhaj Siddiqui.

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Frisbie, J.W., Van Besien, A.J., Lee, A. et al. PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer. Prostate Cancer Prostatic Dis 26, 347–352 (2023). https://doi.org/10.1038/s41391-022-00549-y

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