Rationale and Objectives
To assess the diagnostic performances of prostate specific antigen (PSA) and PSA with
prostate magnetic resonance imaging (MRI) to predict prostate cancer in patients with
PSA ≤ 20 ng/mL.
Materials and methods
Patients suspected of prostate cancer with a PSA test and prebiopsy MRI were included
(n = 881). Prostate biopsy results or follow-up clinical data for 2 years were used
to determine the presence of prostate cancer. The diagnostic performance of PSA, MRI,
and PSA with MRI (referred to as the protocol) was evaluated. The positive predictive
value (PPV) and negative predictive value (NPV) of the MRI were calculated in subgroups
of patients with specific ranges of PSA level.
Results
Prostate cancer and CSC were diagnosed in 220 and 162 patients, respectively. Adding
MRI to PSA could greatly improve specificity and PPV (0.833 and 0.567) for detecting
CSC, compared to PSA ≥ 4 ng/mL alone (0.248 and 0.0219). Even though the sensitivity
of the protocol (0.679) was lower than PSA (0.938), the NPV of the protocol was comparable
to PSA (0.929 vs. 0.924). The protocol consistently showed the superior PPV and NVP
to PSA only in not only patients within the gray zone of PSA, but also in patients
with higher PSA.
Conclusion
In conclusion, this longitudinal observational study confirmed that adding prebiopsy
MRI to PSA was consistently beneficial in patients with PSA ≤ 20 ng/mL for avoiding
unnecessary biopsy despite decrease in the sensitivity.
Key Words
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Article info
Publication history
Published online: September 17, 2022
Accepted:
July 24,
2022
Received in revised form:
July 20,
2022
Received:
July 2,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
