Predictors of prostate carcinoma in PSA gray zone patients with PI-RADS score of 3

Abstract

Our aim was to evaluate the predictors of prostate cancer and clinically significant prostate cancer in patients with prostate-specific antigen (PSA) level between 4-10 ng/ml who had pre-biopsy Prostate Imaging–Reporting and Data System (PI-RADS) score of 3. The study analyzed data from 94 patients who underwent transrectal prostate biopsy with the PI-RADS score of 3 between January 2019 and December 2023. The detection rates of prostate cancer and clinically significant prostate cancer were calculated. Simple and multiple logistic regression analysis were conducted to evaluate the predictors of prostate cancer and clinically significant prostate cancer. The receiver operating characteristics curve analysis and area under curve values were used to determine the priority of parameters. In our study, the incidence of PI-RADS 3 lesion was 18.5%. The overall prostate cancer detection rate was 38.2% with the clinically significant prostate cancer detection rate was 22.3%. For prostate carcinoma and clinically significant prostate carcinoma logistic regression analysis revealed that free to total prostate-specific antigen (f/t PSA) ratio and age were the independent predictors. Receiver Operating Characteristic curve analysis and area under curve revealed that f/t PSA ratio had the highest value (0.770) followed by prostate volume (PV) (0,751) for clinically significant prostate cancer. Prostate-specific antigen density (PSAD) had the third highest area under curve value of 0.739. Although current guidelines recommend not performing biopsy for patients with PSAD<0.10 ng/ml/cc in patients with PI-RADS score 3, our clinically significant prostate cancer detection rate was 13% with this level. Therefore, we recommend that each patient should be evaluated individually with PI-RADS score 3. For deciding on biopsy, not only PSAD but also f/t PSA and PV should be considered, especially in PSA gray zone patients. However, further studies with more patients are required to validate this recommendation.

Keywords

• prostate biopsy
• PI-RADS
• prostate-specific antigen density
• prostate cancer

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