ArticleCureus2025
Diagnostic Accuracy of Combination of Multiparametric MRI PI-RADS Score v2.1 and Prostate-Specific Antigen Density for Prostate Cancer Detection.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Introduction Prostate cancer (PCa) is the second most commonly diagnosed cancer in men worldwide. The Prostate Imaging-Reporting and Data System version 2.1 (PI-RADS v2.1) scoring system using multiparametric magnetic resonance imaging (mp-MRI) increases the accuracy for the assessment of clinically significant PCa. This study evaluates the diagnostic accuracy of a combination of PI-RADS v2.1 scores with prostate-specific antigen density (PSAD) for the detection of PCa, using biopsy outcomes as the gold standard, as well as the diagnostic accuracy of the combination of PI-RADS 3 lesion volume and PSAD. Methods This is single-center cross-sectional retrospective study including 54 subjects with serum PSA values > 4 ng/mL, who were referred for prostate mp-MRI. All patients underwent subsequent transrectal ultrasound (TRUS)-guided biopsy. Data collected includes PSA value, mp-MRI characteristics of the lesion, and histopathological findings. PI-RADS v2.1 score and PSAD were used to evaluate the diagnostic accuracy of this combination. Results In our study, the optimal PSAD cutoff was >0.18 with an area under the curve (AUC) of 0.897, indicating good diagnostic performance. The combination of PI-RADS v2.1 score ≥ 3 and PSAD ≥0.18 increased diagnostic accuracy, with a sensitivity of 96.97% and specificity of 71.43%. However, lesion volume was not a significant predictor of PCa. Conclusion In summary, our study demonstrates that the combination of PI-RADS score and PSAD yields higher diagnostic accuracy for the detection of PCa (p < 0.001) than using the PI-RADS score alone. We found an optimal PSAD cutoff of 0.18, which differs from the international consensus of 0.15. However, it cannot be used as a substitute for definitive pathological diagnosis but can be used in combination for better risk stratification, counselling, and management of patients with elevated PSA levels. Combining PI-RADS 3 lesion volume and PSAD did not have statistically significant results in our study.
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