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. 2024 Nov 24;16(11):e74368.
doi: 10.7759/cureus.74368. eCollection 2024 Nov.

Evaluating the Diagnostic Accuracy of MRI-Derived Prostate-Specific Antigen (PSA) Density in Prostate Cancer Detection and its Association With Tumor Aggressiveness

Syed Yousaf Khalid  1   2 , Tauqir Aslam Waraich  2 , Aiman Elamin  3
Affiliations

Evaluating the Diagnostic Accuracy of MRI-Derived Prostate-Specific Antigen (PSA) Density in Prostate Cancer Detection and its Association With Tumor Aggressiveness

Syed Yousaf Khalid et al. Cureus. .

Abstract

Introduction Prostate-specific antigen density (PSAD), calculated by dividing serum PSA levels by prostate volume, offers greater specificity and accuracy than serum PSA alone in detecting prostate cancer (PCa). This study aimed to evaluate the diagnostic performance of PSAD in PCa detection across different PSA levels and its correlation with Gleason scores. Methods This retrospective, single-center study reviewed data from 154 patients with suspected PCa who underwent prostate MRI between July 2021 and July 2023. Among these, 113 met the inclusion criteria, which required MRI-derived prostate volume measurements, serum PSA levels within three months of biopsy, and transperineal prostate biopsy results. PSAD was calculated by dividing serum PSA levels by prostate volume. Statistical analysis was conducted using STATA/SE 18.0 (StataCorp., College Station, TX, USA). Receiver operating characteristic (ROC) curves identified optimal PSAD cutoff values for PCa detection, and the relationship between PSAD and Gleason scores was analyzed. Results Of the 113 patients, 72 (63.72%) were diagnosed with PCa. The overall PSAD cutoff of 0.158 demonstrated a sensitivity of 73.61% and specificity of 92.68%, with an area under the curve (AUC) of 0.83 (95% CI: 0.77-0.90). For patients with PSA levels between 4-10 ng/ml, the optimal PSAD cutoff was 0.155 (sensitivity 65%, specificity 85.19%). For those with PSA levels >10 ng/ml, the cutoff was 0.175 (sensitivity 96.55%, specificity 66.67%). A significant correlation was found between PSAD and Gleason scores (p < 0.001), with higher PSAD values associated with more aggressive cancers. Conclusion PSAD demonstrates strong diagnostic accuracy for PCa and is significantly correlated with Gleason scores, suggesting its potential in assessing tumor aggressiveness and guiding clinical decisions.

Keywords: gleason score; mri-based psad; prostate cancer; prostate‑specific antigen; prostate‑specific antigen density.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Research Ethics Committee, Letterkenny University Hospital issued approval 24.06.2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Receiver operating characteristic curves for PSAD in differentiating PCa
ROC: receiver operating characteristic; PSAD: prostate-specific antigen density; PCa: prostate cancer
Figure 2
Figure 2. Correlation between PSAD and Gleason score
PSAD: prostate-specific antigen density; *:Kruskal-Wallis test (χ² = 51.591)
See this image and copyright information in PMC

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