The predictive value of multiparametric magnetic resonance imaging in enhancing prostate-specific antigen assessment for prostate cancer: a cross-sectional study.

[BACKGROUND] Prostate-specific antigen (PSA) testing and transrectal ultrasound (TRUS)-guided biopsy remain standard tools for diagnosing prostate cancer (PCa), but both have limitations in sensitivity and specificity, leading to overdiagnosis or missed detection of clinically significant cancers. Multiparametric magnetic resonance imaging (mp-MRI) has emerged as a valuable imaging modality for PCa detection and risk stratification, yet the optimal integration of mp-MRI findings with PSA levels for pre-biopsy assessment remains to be fully established. This study aims to evaluate the predictive value of mp-MRI in enhancing PSA-based assessment for clinically significant PCa.

[METHODS] This cross-sectional study involved patients with clinically suspected PCa who underwent mp-MRI prior to systematic biopsy guided by TRUS.

[RESULTS] A total of 192 patients with suspected PCa underwent mp-MRI before biopsy guided by TRUS. Grouping by Gleason score revealed that patients with a Gleason score of <7 had significantly lower PSA levels, PSA density, maximum lesion diameter, total lesion volume, and lesion density compared to those with a Gleason score of ≥7. Similarly, when grouped by Prostate Imaging Reporting and Data System (PI-RADS) grade, patients with a PI-RADS score of ≤2 had significantly lower values in these parameters compared to those with a PI-RADS score of ≥3. Multivariate logistic regression analysis demonstrated that patients with high PSA levels and positive mp-MRI results had an increased risk of PCa. The sensitivity and specificity of mp-MRI for diagnosing PCa were 73.7% and 81.7%, respectively, with an area under the curve (AUC) of 0.777 [95% confidence interval (CI): 0.725-0.829]. For PSA (cutoff =6.87, determined using the Youden index from the ROC curve), the sensitivity was 80.0%, specificity was 74.6%, and AUC was 0.745 (95% CI: 0.678-0.813). This cutoff value was derived by identifying the point on the ROC curve that maximizes the sum of sensitivity and specificity, thereby optimizing diagnostic performance. Patients with PSA levels above this threshold were considered at higher risk for clinically significant PCa in the subsequent regression and model analysis. The combined use of positive mp-MRI and PSA resulted in an AUC of 0.854 (95% CI: 0.806-0.902).

[CONCLUSIONS] For men at clinical risk for PCa who have not previously undergone biopsy, the risk assessment using mp-MRI prior to biopsy is superior to standard TRUS-guided biopsy.