Unlocking Precision Enhancing Prostate Cancer Detection and Reducing Unnecessary Biopsies with Combined Prostate-Specific Antigen Density and PI-RADS Score.

Objective: To determine clinically significant prostate cancer (csPCa) detection rate by combining the prostate-specific antigen density (PSAD) and prostate imaging-reporting and data system (PI-RADS) scores.

Study design: Descriptive study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Ankara Oncology Training and Research Hospital, from January 2018 to April 2023.

Methodology: Patients who underwent prostate biopsies after multiparametric magnetic resonance imaging (mpMRI) were included in the study. PI-RADS 4 and 5 lesions were considered as MR positive. The cut-off values for PSAD were also determined to evaluate csPCa. csPCa detection rates were evaluated by grouping the patients based on the PSAD and mpMRI findings.

Results: PSAD cut-off value of 0.165 ng/mL/mL (sensitivity 80%, specificity 72%) was detected to predict csPCa (AUC = 0.81, 95% CI:0.756-0.866, p<0.001). csPCa detection rate was low (3%) in patients who have low PI-RADS scores (1-3) and a PSAD <0.165 ng/mL/mL. On the other hand, csPCa detection rate was high (50.5%) in patients who have a high PI-RADS score (4-5 lesions) and with a PSAD ≥0.165 ng/mL/mL.

Conclusion: csPCa detection rates are low in patients with PI-RADS 1-3 lesions and low PSAD values. Unnecessary biopsy may be avoided in these patients.

Key words: Gleason score, PI-RADS, Prostate cancer, Prostate-specific antigen, Prostate-specific antigen density.