PI-RADS v2.1 Combined With Prostate-Specific Antigen Density for Detection of Prostate Cancer in Peripheral Zone

Abstract

PurposeTo evaluate the diagnostic performance of combining the Prostate Imaging Reporting and Data System (PI-RADS) scoring system v2.1 with prostate-specific antigen density (PSAD) to detect prostate cancer (PCa).MethodsA total of 266 participants with suspicion of PCa underwent multiparametric magnetic resonance imaging (mpMRI) in our hospital, after at least 4 weeks all patients underwent subsequent systematic transrectal ultrasound (TRUS)-guided biopsy or MRI-TRUS fusion targeted biopsy. All mpMRI images were scored in accordance with the PI-RADS v2.1, and univariate and multivariate logistic regression analyses were performed to determine significant predictors of PCa.ResultsA total of 119 patients were diagnosed with PCa in the biopsy, of them 101 patients were diagnosed with clinically significant PCa. The multivariate analysis revealed that PI-RADS v2.1 and PSAD were independent predictors for PCa. For peripheral zone (PZ), the area under the ROC curve (AUC) for the combination of PI-RADS score and PSAD was 0.90 (95% CI 0.83-0.96), which is significantly superior to using PI-RADS score (0.85, 95% CI 0.78-0.93, P=0.031) and PSAD alone (0.83, 95% CI 0.75-0.90, P=0.037). For transition zone (TZ), however, the combination model was not significantly superior to PI-RADS alone, with AUC of 0.94 (95% CI 0.89-0.99) vs. 0.93 (95% CI 0.88-0.97, P=0.186).ConclusionThe combination of PI-RADS v2.1 with PSAD could significantly improve the diagnostic performance of PCa in PZ. Nevertheless, no significant improvement was observed regarding PCa in TZ.