Share：
Share this content in WeChat
X
[Chinese] [PDF] 4 1
• Clinical Article •
The diagnostic value of based on the PI-RADS v2.1 score of Bp-MRI combined with PSAD risk stratification for predicting tPSA 4-20 ng/mL in clinically significant prostate cancer
ZHANG Ruodi  LIN Zijing  FENG Xianlun  LI Peng  CHEN Zhiqiang 

DOI:10.12015/issn.1674-8034.2025.11.022.


[Abstract] Objective To explore the value and risk stratification of based on biparametric magnetic resonance imaging (bp-MRI) of prostate imaging report and data system version 2.1 (PI-RADS v2.1) combined with prostate specific antigen density (PSAD) in the differential diagnosis of clinically significant prostate cancer (csPCa) with tPSA 4-20 ng/mL.Materials and Methods Retrospectively analyzed the data of 304 patients undergoing bp-MRI examination with pathological results between October 2017 and June 2023 in the General Hospital of Ningxia Medical University. The patients were divided into csPCa group (Gleason ≥ 7, n = 66) and non-csPCa (Gleason < 7 and benign diseases, n = 238) according to the pathological results. The independent risk factors were screened by univariate and multivariate logistic regression analysis, then the clinical model was constructed, and the clinical net benefit was analyzed by decision curve (DCA). Diagnostic performance was evaluated by using the area under the receiver operating characteristic (ROC) curve, and the independent risk factors were graded and combined.Results The diagnostic efficacy of clinical model (PI-RADS v2.1 + PSAD) is the best (AUC = 0.901, 95% CI: 0.858 to 0.944). Classify and combine PI-RADS v2.1 and PSAD grades, when PI-RADS v2.1 ≤ 2 and PSAD ≤ 0.15 ng/mL2, the csPCa positive rate is 0%; when PI-RADS v2.1 = 3 and PSAD < 0.30 ng/mL2, the csPCa positive rate is less than 15%; when PI-RADS v2.1 is 4 to 5 and PSAD is 0.15 to 0.29 ng/mL2, the csPCa positive rate is 46.5%; when PI-RADS v2.1 is 4 to 5 and PSAD ≥ 0.30 ng/mL2, the csPCa positive rate is as high as 81.3%.Conclusions The patients with PI-RADS v2.1 ≤ 2 or PI-RADS v2.1 = 3 and PSAD < 0.30 ng/mL2 can avoid unnecessary biopsies. PI-RADS v2.1 combined with PSAD can significantly improve the diagnostic efficiency of tPSA 4-20 ng/mL csPCa. The combination of PI-RADS v2.1 and PSAD is helpful for risk assessment of patients with csPCa before puncture, so as to can reduce unnecessary puncture of some patients and provide certain decision-making guidance for clinic.
[Keywords] clinically significant prostate cancer；magnetic resonance imaging；prostate imaging reporting and data scoring system version 2.1；prostate specific antigen density；diagnostic efficacy

ZHANG Ruodi1, 2, 3   LIN Zijing1   FENG Xianlun1   LI Peng2   CHEN Zhiqiang1, 2*  

1 Department of Radiology, the First Hospital Affiliated to Hainan Medical University, Haikou 570102

2 Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004

3 Department of Radiology, the First Hospital Affiliated to Xi'an Medical College, Xi'an 710077

Corresponding author: CHEN Z Q, E-mail: zhiqiang_chen99@163.com

Conflicts of interest   None.

Received  2025-07-18
Accepted  2025-11-10
DOI: 10.12015/issn.1674-8034.2025.11.022
DOI:10.12015/issn.1674-8034.2025.11.022.

[1]
JIN P F, SHEN J K, YANG L Q, et al. Machine learning-based radiomics model to predict benign and malignant PI-RADS v2.1 category 3 lesions: a retrospective multi-center study[J/OL]. BMC Med Imaging, 2023, 23(1): 47 [2025-03-26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053087. DOI: 10.1186/s12880-023-01002-9.
[2]
GURWIN A, KOWALCZYK K, KNECHT-GURWIN K, et al. Alternatives for MRI in prostate cancer diagnostics: review of current ultrasound-based techniques[J/OL]. Cancers, 2022, 14(8): 1859 [2025-03-26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9028694. DOI: 10.3390/cancers14081859.
[3]
CAO W, CHEN H D, YU Y W, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020[J]. Chin Med J (Engl), 2021, 134(7): 783-791. DOI: 10.1097/CM9.0000000000001474.
[4]
HE J, CHEN W Q, LI N, et al. China guideline for the screening and early detection of prostate cancer(2022, Beijing)[J]. China Cancer, 2022, 31(1): 1-30. DOI: 10.11735/j.issn.1004-0242.2022.01.A001.
[5]
TURKBEY B, ROSENKRANTZ A B, HAIDER M A, et al. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2[J]. Eur Urol, 2019, 76(3): 340-351. DOI: 10.1016/j.eururo.2019.02.033.
[6]
SCHOOTS I G, BARENTSZ J O, BITTENCOURT L K, et al. PI-RADS committee position on MRI without contrast medium in biopsy-naive men with suspected prostate cancer: narrative review[J]. AJR Am J Roentgenol, 2021, 216(1): 3-19. DOI: 10.2214/AJR.20.24268.
[7]
WANG Z B, WEI C G, ZHANG Y Y, et al. The role of psa density among PI-RADS v2.1 categories to avoid an unnecessary transition zone biopsy in patients with PSA 4-20 ng/mL[J/OL]. Biomed Res Int, 2021, 2021: 3995789 [2025-03-26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9028694. DOI: 10.1155/2021/3995789.
[8]
NAN L B, YIN X T, GAO J P. Significant diagnostic value of free-serum PSA (FPSA)/prostate-specific antigen density (PSAD) and (F/T)/PSAD for prostate cancer of the Chinese population in a single institution[J]. Med Sci Monit, 2019, 25: 8345-8351. DOI: 10.12659/MSM.916900.
[9]
HATAKEYAMA S, YONEYAMA T, TOBISAWA Y, et al. Narrative review of urinary glycan biomarkers in prostate cancer[J]. Transl Androl Urol, 2021, 10(4): 1850-1864. DOI: 10.21037/tau-20-964.
[10]
CHANG T H, LIN W R, TSAI W K, et al. Zonal adjusted PSA density improves prostate cancer detection rates compared with PSA in Taiwan males with PSA < 20 ng/ml[J/OL]. BMC Urol, 2020, 20(1): 151 [2025-03-26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542736. DOI: 10.1186/s12894-020-00717-z.
[11]
BAI X J, JIANG Y M, ZHANG X W, et al. The value of prostate-specific antigen-related indexes and imaging screening in the diagnosis of prostate cancer[J]. Cancer Manag Res, 2020, 12: 6821-6826. DOI: 10.2147/CMAR.S257769.
[12]
MA Z N, WANG X C, ZHANG W C, et al. Developing a predictive model for clinically significant prostate cancer by combining age, PSA density, and mpMRI[J/OL]. World J Surg Oncol, 2023, 21(1): 83 [2025-03-26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9990202. DOI: 10.1186/s12957-023-02959-1.
[13]
WEI X T, XU J M, ZHONG S Y, et al. Diagnostic value of combining PI-RADS v2.1 with PSAD in clinically significant prostate cancer[J]. Abdom Radiol (NY), 2022, 47(10): 3574-3582. DOI: 10.1007/s00261-022-03592-4.
[14]
WANG C M, YUAN L, SHEN D Y, et al. Combination of PI-RADS score and PSAD can improve the diagnostic accuracy of prostate cancer and reduce unnecessary prostate biopsies[J/OL]. Front Oncol, 2022, 12: 1024204 [2025-03-26]. https://doi.org/10.3389/fonv.2022.1024204. DOI: 10.3389/fonc.2022.1024204.
[15]
EPSTEIN J I, EGEVAD L, AMIN M B, et al. The 2014 international society of urological pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system[J]. Am J Surg Pathol, 2016, 40(2): 244-252. DOI: 10.1097/PAS.0000000000000530.
[16]
CHENG Y B, QIU X F, GUO H Q. Interpretation of the 2025 update to EUA prostate cancer guideline[J]. Chin J Surg Oncol, 2025, 17(3): 216-220. DOI: 10.3969/j.issn.1674-4136.2025.03.002.
[17]
SCOTT R, MISSER S K, CIONI D, et al. PI-RADS v2.1: What has changed and how to report[J/OL]. S Afr N J Radiol, 2021, 25(1) [2025-03-26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252188. DOI: 10.4102/sajr.v25i1.2062.
[18]
YUSIM I, KRENAWI M, MAZOR E, et al. The use of prostate specific antigen density to predict clinically significant prostate cancer[J/OL]. Sci Rep, 2020, 10(1): 20015 [2025-03-26]. https://doi.org/10.1038/s41598-020-76786-9. DOI: 10.1038/s41598-020-76786-9.
[19]
DAI Z J, CHEN X H, CHEN D Z, et al. Diagnostic value of PI-RADS v2.1 for clinically significant prostate cancer[J]. Chin Comput Med Imag, 2024, 30(1): 75-79. DOI: 10.19627/j.cnki.cn31-1700/th.2024.01.019.
[20]
LIN Y R, WEI X H, UHLMAN M, et al. PSA density improves the rate of prostate cancer detection in Chinese men with a PSA between 2.5-10.0 ng ml (-1) and 10.1-20.0 ng ml (-1): a multicenter study[J]. Asian J Androl, 2015, 17(3): 503-507. DOI: 10.4103/1008-682X.142129.
[21]
HUANG D D, FENG Q R, LI Z H, et al. Diagnosis value of BP-MRI combined clinical predictors for prostate cancer[J]. Chin J Magn Reson Imag, 2023, 14(10): 90-97. DOI: 10.12015/issn.1674-8034.2023.10.016.
[22]
ZHANG D, ZHANG S R, SONG N, et al. The value of PI-RADS v2.1 combined with psad stratification in predicting peripheral zone clinically significant prostate cancer in patients with psa 4-20 ng/mL[J]. Chin Comput Med Imag, 2023, 29(6): 631-636. DOI: 10.19627/j.cnki.cn31-1700/th.2023.06.003.
[23]
PAN M J, QI F, CHENG Y F, et al. The value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20 ng/ml[J]. Chin J Urol, 2021(1): 18-22. DOI: 10.3760/cma.j.cn112330-20200302-00145.
[24]
GÖRTZ M, RADTKE J P, HATIBOGLU G, et al. The value of prostate-specific antigen density for prostate imaging-reporting and data system 3 lesions on multiparametric magnetic resonance imaging: A strategy to avoid unnecessary prostate biopsies[J]. Eur Urol Focus, 2021, 7(2): 325-331. DOI: 10.1016/j.euf.2019.11.012.
[25]
HU C H, QIAO X M, HU J S, et al. The utility of deep learning-clinical combined model based on bi-parametric MRI for diagnosis of clinically significant prostate cancer[J]. Chin J Magn Reson Imag, 2024, 15(2): 90-96. DOI: 10.12015/issn.1674-8034.2024.02.013.
[26]
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 Imag, 2025, 16(4): 81-86, 107. DOI: 10.12015/issn.1674-8034.2025.04.012.
[27]
WANG G, YU G, CHEN J, et al. Can high b-value 3.0 T biparametric MRI with the Simplified Prostate Image Reporting and Data System (S-PI-RADS) be used in biopsy-naïve men[J]. Clin Imag, 2022, 88: 80-86. DOI: 10.1016/j.clinimag.2021.06.024.
[28]
ALABOUSI M, SALAMEH J P, GUSENBAUER K, et al. Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment-naïve patients: a diagnostic test accuracy systematic review and meta-analysis[J]. BJU Int, 2019, 124(2): 209-220. DOI: 10.1111/bju.14759.
[29]
HUANG H, LIU Z H, MA Y, et al. Based on PI-RADS v2.1 combining PHI and ADC values to guide prostate biopsy in patients with PSA 4-20 ng/mL[J]. Prostate, 2024, 84(4): 376-388. DOI: 10.1002/pros.24658.
[30]
FAN D M. CACA Guidelines for holistic lntegrative management of cancer[M]. Tianjin: Tianjin Scientific & Technical Publishers, 2022: 1-68.
[31]
DASGUPTA P, DAVIS J, HUGHES S. NICE guidelines on prostate cancer 2019[J/OL]. BJU Int, 2019, 124(1): 1 [2025-03-26]. https://doi.org/10.1111/bju.14815. DOI: 10.1111/bju.14815.
[32]
MOTTET N, VAN DEN BERGH R C N, BRIERS E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. part 1: screening, diagnosis, and local treatment with curative intent[J]. Eur Urol, 2021, 79(2): 243-262. DOI: 10.1016/j.eururo.2020.09.042.
[33]
LEI Y, LI T J, GU P, et al. Combining prostate-specific antigen density with prostate imaging reporting and data system score version 2.1 to improve detection of clinically significant prostate cancer: A retrospective study[J/OL]. Front Oncol, 2022, 12: 992032 [2025-03-26]. https://pubmed.ncbi.nlm.nih.gov/36212411/. DOI: 10.3389/fonc.2022.992032.
[34]
WEN J, TANG T T, JI Y G, et al. PI-RADS v2.1 combined with prostate-specific antigen density for detection of prostate cancer in peripheral zone[J/OL]. Front Oncol, 2022, 12: 861928 [2025-03-26]. https://pubmed.ncbi.nlm.nih.gov/35463349/. DOI: 10.3389/fonc.2022.861928.

PREV Prediction of zonal heterogeneity in prostate cancer using multi-parametric magnetic resonance habitat imaging
NEXT Delta MRI-based radiomics for predicting risk factors in cervical cancer patients after neoadjuvant chemotherapy
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn