ArticleThe Canadian journal of urology2026
Analysis of risk factors for MRI-invisible prostate cancer-the significance of AGGF1 immunohistochemical detection and PSAD.
Article in The Canadian journal of urology, 2026. 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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Abstract
objectivesPatients with a multi-parameter magnetic resonance imaging (mpMRI) prostate imaging report and data system (PI-RADS) score ≤ 3, but with clinically significant prostate cancer (CSPCa) detected by biopsy, are termed MRI-Invisible prostate cancer (MRI(-)PCa). This study aims to explore risk factors for MRI(-)PCa and identify immunohistochemical indicators with predictive significance.
methodsA retrospective analysis was conducted on 376 patients with PI-RADS score ≤ 3 who underwent 24-needle systematic prostate biopsy at Beijing Friendship Hospital, Capital Medical University (January 2015 to October 2025). Clinical data, imaging data, and Angiogenic factor with G and FHA domain 1 (AGGF1) immunohistochemical results were collected. Patients were grouped into CSPCa (n = 102) and non-CSPCa (n = 274). t-tests, rank sum tests, and χ2 tests were used for univariate analysis, followed by multivariate Logistic regression to determine independent risk factors. Receiver Operating Characteristic (ROC) curves were drawn. Subgroup analyses were conducted based on prostate-specific antigen (PSA) status and PI-RADS score using the same statistical methods. Moreover, we also used the Kruskal-Wallis test to compare the differences in AGGF1 expression percentages across different Gleason score groups according to ISUP in CSPCa patients.
resultsMultivariate Logistic regression analysis showed that prostate-specific antigen density (PSAD) [OR: 0.971, 95%CI: 0.952, 0.991] and high expression of AGGF1 [OR: 1.065, 95%CI: 1.022, 1.109] were independent risk factors for MRI(-)PCa (p < 0.05). Meanwhile, when the PSAD of the patient is more than 0.25 ng/mL/cm3, it is necessary to be more suspicious that the patient may have prostate cancer (p < 0.05), and an AGGF1 immunohistochemical analysis should be conducted after the biopsy. In the PSA-negative subgroup, only high AGGF1 expression was an independent risk factor (p < 0.05). In the PSA-positive subgroup, PSAD [OR: 0.500, 95%CI: 0.279, 0.895] and AGGF1 [OR: 1.064, 95%CI: 1.037, 1.092] results were independent risk factors (p < 0.05). In subgroup analyses for PI-RADS 1-2 and PI-RADS 3, both PSAD and AGGF1 were accurate predictors of CSPCa (p < 0.05). Among all CSPCa patients, in the Gleason score 3 + 3 group, the average AGGF1 expression percentage of the patients was 48.60% ± 11.03%, which was significantly lower than that of the Gleason score 4 + 3 group (61.00% ± 6.12%) and the Gleason score 4 + 4 group (71.01% ± 4.46%), and the differences were statistically significant (p < 0.001).
conclusionsFor patients with a PI-RADS score ≤ 3, attention should be paid to PSAD before biopsy, especially for those patients with PSAD > 0.25 ng/mL/cm3, not just PSA levels. After biopsy, AGGF1 immunohistochemical staining can be supplemented to help determine the risk and the malignancy of CSPCa.
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