Improving Detection Rate Of Prostate Cancer Combined PI-RADS V2 With PSA,PSA-AV And Its Derived Data

BackgroundTo establish a new accumulating model to enhance the accuracy of prostate cancer(PCa)diagnosis by incorporating prostate-specific antigen(PSA),prostate-specific antigen-age volume(PSA-AV)and its derivative data into the Prostate Imaging-Reporting and Data System version 2(PI-RADS v2)MethodsA retrospective analysis of 497 patients who underwent prostate examination in our hospital from January 2014 to December 2018.Finally,a total of 357 patients were included in this study with a median age of 68 and a range of 63-74.All patients had 3.0T multiparametric magnetic resonance imaging(mpMRI)and complete laboratory examinations.PI-RADS v2 was used to assess the imaging.PSA,PSA density(PSAD),PSA-AV,the free/total and PSA ratio(f/t PSA)as clinical indicators.According to the pathological results,they were divided into benign prostatic hyperplasia(BPH)group,PCa group,and clinically significant PCa(CS PCa).Combining with PI-RADS v2,PSA-AV was used as a new parameter to test its efficacy in the diagnosis of PCa.PSA,PSA density(PSAD),the free/total PSA ratio(f/t PSA)and the Gleason score(GS)were classified into four-tiered levels,and optimal weights were pursued on these managed levels to build a PCa accumulating model.One-way analysis of variance(ANOVA)was used to compare the differences in PCa and BPH groups.A receiver operating characteristic curve was generated.P<0.05 was considered to be statistically significant,p<0.001 was considered to be significant statistically significant.ResultsIn all,174 patients(48.7%)had benign prostatic hyperplasia,and 183(51.3%)had PCa,among whom 149(81.4%,149/183)had CS PCa.or the PCa group,there were 34 cases of GS 6(group 2),74 cases of GS 7(group 3),and 75 cases of(75/183)GS 8-10(group 4).The PSA-AV,PSA subgroup,PSAD subgroup,f/t PSA subgroup,and PI-RADS v2 have significant correlations with PCa and CS PCa.PI-RADS v2 score>4 could detect PCa with rate of 82.1%.Serum tPSA>10 ng/ml could detect PCa with rate of 66.2%.PSA-AV<250 could detect PCa with rate of 83.5%.Combining with PSA-AV<250,Patients those with tPSA 4-10 ng/ml could improve the detection from 36.0%up to 81%,those with PI-RADS v2 score 3 from 28.6%up to 60.0%.The area under the curve(AUC),sensitivity,and specificity of PCa in PI-RADS v2 were 0.821,75.8%,and 82.8%,respectively;of CS PCa,with AUC,sensitivity,and specificity of 0.86,83.4%,and 83.0%,respectively.The established model 6(PI-RADS v2+level of PSAD+level of f/t PSA+level of PSA)had a AUC,sensitivity and specificity of 0.884,81.4%and 84.5%,respectively,at the cut-off point of 11 in PCa diagnosis.Correspondingly,at the 12 cut-off point,the AUC,sensitivity and specificity were 0.913,87.7%and 83.0%,respectively,in diagnosing CS PCa.The score of the new accumulating system mode;6 was significantly different among the defined GS groups(p<0.001).The mean values and 95%confidence intervals for GS 1-4 groups were 10.20(9.63-10.40),12.03(11.19-12.87),14.12(13.60-14.64)and 15.44(15.09-15.79).Conclusions1.The PSA,PSAD,f/t PSA,PSA-AV and PI-RADS v2 have significant correlations with PCa and CS PCa2.For patients those in gray zone,PSA-AV can improve detection rate of PCa.3.Combined PI-RADS v2 with PSA and its derived data helps to improve the accuracy of PCa and CS PCa diagnosis.The integration model may be more conducive to clinical application4.There is a strong correlation between the newly established PCa diagnostic model score and pathological grade,which is helpful for the clinical decision of whether to perform biopsy or not when the MRI result is negative.