Work

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

Year: 2021

Type: article

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.

Source: BioMed Research International

DOI: 10.1155/2021/3995789