Comprehensive diagnostic model of metastasis in prostate cancer: Individual and combined bioscore model of ADC value, Gleason score, and PSA

Abstract

AbstractProstate cancer (PCa) metastasis significantly influences treatment decisions and prognosis. This study evaluated the individual and combined diagnostic ability of apparent diffusion coefficient (ADC), Gleason score and prostate‐specific antigen (PSA) in detecting metastasis. The study included data from 120 biopsy‐confirmed PCa patients treated from 2019 to 2023. Whole‐body MRI images, incorporating high‐resolution T2 and axial DWI sequences, were evaluated by experienced radiologists. Receiver operating characteristic (ROC) curves and logistic regression models were used to assess the diagnostic performance of ADC, Gleason score, and PSA in detecting metastasis. The prevalence of PCa metastasis was 25.0%, with pelvic lymph node metastasis (16.7%) and bony metastasis (12.5%) being most prevalent. Patients with PCa metastasis had significantly lower ADC values, higher Gleason scores, and higher PSA levels compared to those without metastasis. Individually, an ADC cut‐off of ≤549.00 mm2/s was the best marker for detecting metastasis. The combined bioscore model including PSA, ADC values and Gleason score was the best independent predictor, correlating with a 159‐fold increased likelihood of detecting PCa metastasis. This study demonstrated the prognostic ability of PCa markers in detecting metastasis. ADC was an independent, sensitive, specific, and accurate diagnostic marker. The combined bioscore model of ADC, PSA and Gleason score significantly enhanced the identification of patients with PCa metastasis.