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• Clinical Article •
Predictive value of ADCmean combined with PSAD in clinically significant prostate cancer with PI-RADS score ≥ 3
BEI Mingjie  XU Jingfang  ZHU Xin 

Cite this article as: BEI M J, XU J F, ZHU X. Predictive value of ADCmean combined with PSAD in clinically significant prostate cancer with PI-RADS score ≥ 3[J]. Chin J Magn Reson Imaging, 2025, 16(4): 81-86, 107 DOI:10.12015/issn.1674-8034.2025.04.012.


[Abstract] Objective To investigate the predictive value of mean apparent diffusion coefficient (ADCmean) combined with prostate specific antigen density (PSAD) for clinically significant prostate cancer (csPCa) with a prostate imaging reporting and data system version (PI-RADS) score ≥ 3.Materials and Methods Clinical data and imaging data of patients with PI-RADS score ≥ 3 on prostate MRI performed at our hospital between February 2022 and August 2024 and with pathologic histology were retrospectively analyzed. The highest PI-RADS score and the largest dimension of the largest lesion were selected for ROI outlining, and the ADCmean and apparent diffusion coefficient min (ADCmin) of the lesion were measured. Univariate and multivariate logistic regression analyses were performed to identify the best clinical and imaging predictors of csPCa. Receiver operating characteristics (ROC) curves and the DeLong test were used to compare the diagnostic efficacy of the best clinical and imaging predictive models and their combined models by calculating the area under the curve (AUC), sensitivity and specificity.Results A total of 75 (48.39%) csPCa patients and 80 (51.61%) non-csPCa patients were included in this study. age, total prostate specific antigen (tPSA), free prostate specific antigen (fPSA), and PSAD were greater in the csPCa group than in the non-csPCa group, and prostate volume (PV), fPSA and tPSA ratio (f/t), ADCmin, and ADCmean were smaller in the csPCa group than in the non-csPCa group, and the differences were statistically significant (P < 0.05). Stepwise logistic regression analysis and comparison of ROC curves yielded the best clinical indicator PSAD and imaging indicator ADCmean for predicting csPCa, with an AUC of 0.846 for PSAD and 0.898 for ADCmean, and an optimal cutoff value of 0.307 ng/mL2 for PSAD, with a sensitivity of 66.67% and a specificity of 91.25%; ADCmean had an optimal cutoff value of 773.5 mm2/s, a sensitivity of 86.67%, and a specificity of 85.00%; the AUC of the two combined models was as high as 0.925, and the difference in diagnostic efficacy between the combined model and the single model was statistically significant using DeLong's test (P < 0.05). The sensitivity and specificity of the combined model for predicting csPCa were 86.67% and 88.75%.Conclusions The predictive efficacy of ADCmean for csPCa with PI-RADS ≥ 3 points was better than that of ADCmin, and the combined model with PSAD can further improve the predictive value of csPCa with PI-RADS ≥ 3 points, which is instructive for clinical diagnosis and treatment.
[Keywords] clinically significant prostate cancer；prostate-specific antigen density；magnetic resonance imaging；prostate imaging reporting and data system；apparent diffusion coefficient

BEI Mingjie   XU Jingfang   ZHU Xin*  

Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

Corresponding author: ZHU X, E-mail: 66zhuxin@163.com

Conflicts of interest   None.

Received  2025-01-06
Accepted  2025-04-02
DOI: 10.12015/issn.1674-8034.2025.04.012
Cite this article as: BEI M J, XU J F, ZHU X. Predictive value of ADCmean combined with PSAD in clinically significant prostate cancer with PI-RADS score ≥ 3[J]. Chin J Magn Reson Imaging, 2025, 16(4): 81-86, 107 DOI:10.12015/issn.1674-8034.2025.04.012.

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