ArticleEuropean radiology2024
Reduction of false positives using zone-specific prostate-specific antigen density for prostate MRI-based biopsy decision strategies.
Article in European radiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 15 citations in OpenAlex.
- Reference values for PSA, PSA density, and MRI prostate volume in healthy German men.European radiology · 2026Article
- Current status and future directions of AI in prostate cancer detection on MRI: a special report from the ESUR prostate MRI working group authors.European radiology · 2026Article
- mpMRI-based clinic-radiomics-deep learning model integrating lesion and PPAT for predicting csPCa in PI-RADS category 3 lesions: a multicenter study.International urology and nephrology · 2026Article
- Imaging-based clinical decision tree enables risk stratification of extraprostatic extension before radical prostatectomy in prostate cancer patients.Insights into imaging · 2026Article
- Automatic segmentation of the urethra and prostate zones with deep learning on T2-weighted magnetic resonance imaging.Physics and imaging in radiation oncology · 2026Article
- A nomogram using transition zone PSA density for detecting clinically significant prostate cancer in PI-RADS 3 lesions.Scientific reports · 2025Article
- Effective reduction of unnecessary biopsies through a deep-learning-assisted aggressive prostate cancer detector.Scientific reports · 2025Article
- Artificial intelligence-assisted enhancement of prostate volume metrics in the diagnosis of clinically significant prostate cancer: a retrospective analysis.Quantitative imaging in medicine and surgery · 2025Article
- Multimodal approach to optimize biopsy decision-making for PI-RADS 3 lesions on multiparametric MRI.Clinical imaging · 2025Article
- Detecting Clinically Significant Prostate Cancer in PI-RADS 3 Lesions Using T2w-Derived Radiomics Feature Maps in 3T Prostate MRI.Current oncology (Toronto, Ont.) · 2024Article
- Multiparametric MRI for characterization of the tumour microenvironment.Nature reviews. Clinical oncology · 2024Review
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Authors and funding
16 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo develop and test zone-specific prostate-specific antigen density (sPSAD) combined with PI-RADS to guide prostate biopsy decision strategies (BDS).
methodsThis retrospective study included consecutive patients, who underwent prostate MRI and biopsy (01/2012-10/2018). The whole gland and transition zone (TZ) were segmented at MRI using a retrained deep learning system (DLS; nnU-Net) to calculate PSAD and sPSAD, respectively. Additionally, sPSAD and PI-RADS were combined in a BDS, and diagnostic performances to detect Grade Group ≥ 2 (GG ≥ 2) prostate cancer were compared. Patient-based cancer detection using sPSAD was assessed by bootstrapping with 1000 repetitions and reported as area under the curve (AUC). Clinical utility of the BDS was tested in the hold-out test set using decision curve analysis. Statistics included nonparametric DeLong test for AUCs and Fisher-Yates test for remaining performance metrics.
resultsA total of 1604 patients aged 67 (interquartile range, 61-73) with 48% GG ≥ 2 prevalence (774/1604) were evaluated. By employing DLS-based prostate and TZ volumes (DICE coefficients of 0.89 (95% confidence interval, 0.80-0.97) and 0.84 (0.70-0.99)), GG ≥ 2 detection using PSAD was inferior to sPSAD (AUC, 0.71 (0.68-0.74)/0.73 (0.70-0.76); p < 0.001). Combining PI-RADS with sPSAD, GG ≥ 2 detection specificity doubled from 18% (10-20%) to 43% (30-44%; p < 0.001) with similar sensitivity (93% (89-96%)/97% (94-99%); p = 0.052), when biopsies were taken in PI-RADS 4-5 and 3 only if sPSAD was ≥ 0.42 ng/mL/cc as compared to all PI-RADS 3-5 cases. Additionally, using the sPSAD-based BDS, false positives were reduced by 25% (123 (104-142)/165 (146-185); p < 0.001).
conclusionUsing sPSAD to guide biopsy decisions in PI-RADS 3 lesions can reduce false positives at MRI while maintaining high sensitivity for GG ≥ 2 cancers. CLINICAL RELEVANCE STATEMENT: Transition zone-specific prostate-specific antigen density can improve the accuracy of prostate cancer detection compared to MRI assessments alone, by lowering false-positive cases without significantly missing men with ISUP GG ≥ 2 cancers. KEY POINTS: • Prostate biopsy decision strategies using PI-RADS at MRI are limited by a substantial proportion of false positives, not yielding grade group ≥ 2 prostate cancer. • PI-RADS combined with transition zone (TZ)-specific prostate-specific antigen density (PSAD) decreased the number of unproductive biopsies by 25% compared to PI-RADS only. • TZ-specific PSAD also improved the specificity of MRI-directed biopsies by 9% compared to the whole gland PSAD, while showing identical sensitivity.
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