The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients

C. Bostancı, D.Ö. Demir
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Abstract

Objective

To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients.

Methods

191 patients with PSA levels between 4−10 mg/mL and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/mL/mL, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters, which were PSAD 0.01−0.07 ng/mL/mL and f/t PSA ratio ≥25 in a low-risk group, PSAD 0.08−0.15 ng/mL/mL, and f/t PSA ratio 0.15−0.24 in an intermediate-risk group and high-risk group, in which PSAD > 0.15 ng/mL/mL and f/t PSA ratio <15.

Results

NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD < 0.15 ng/mL/mL and f/t PSA > 15.

Conclusion

f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/mL/mL and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study.

前列腺特异性抗原衍生物与多参数前列腺磁共振成像评分相结合对灰色地带患者其阴性预测值的影响。
目的:计算阴性多参数前列腺磁共振成像(mpMRI)的阴性预测值(NPV),当与灰色地带患者的前列腺特异性抗原密度(PSAD)和游离/总前列腺特异性抗体比率(f/tPSA)相结合时,该成像在图像上被视为无病变。方法:191名PSA水平在4-10之间的患者 mg/ml和阴性mpMRI进行分析。根据0.15的PSAD水平以及两者的组合计算阴性mpMRI的NPV。根据这两个参数将患者分为三个风险组,PSAD为0.01-0.07 低风险组的ng/ml/ml和f/t PSA比值≥25,PSAD 0.08-0.15 在中危组和高危组中,ng/ml/ml和f/t PSA比率为0.15-0.24,其中PSAD > 0.15 结果:临床意义前列腺癌mpMRI阴性的NPV为92.6%。在低风险组中它增加到97.5%,在高风险组中CSPCa降低到33.3%。当与PSAD结合时,阴性mpMRI结果的NPV非常接近  15.结论:f/t-PSA比值也可能与PSAD一样用于增加mpMRI的NPV。当PSAD大于0.15时,我们建议不要避免前列腺活检 ng/ml/ml,f/t PSA比率为
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