Li Yue, Zhou Shan, Chen Jing, Mao Fei, Niu Xiao-Bing, Sun Li, Xu Ming, Liu Jin-Tao
Department of Ultrasound, Huai'an First Hospital Affiliated to Nanjing Medical University, Huai'an, Jiangsu 223001, China.
Department of Urology, Huai'an First Hospital Affiliated to Nanjing Medical University, Huai'an, Jiangsu 223001, China.
Zhonghua Nan Ke Xue. 2025 Jan;31(1):50-54.
To assess the value of the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) score combined with PSA density (PSAD) in the diagnosis of clinically significant prostate cancer (CSPCa) in the PSA grey zone by MRI-TRUS cognitive fusion-guided transperineal targeted prostate biopsy.
This retrospective study included 327 male patients with total PSA (tPSA) levels of 4-10 μg/L undergoing MRI-TRUS cognitive fusion-guided transperineal targeted prostate biopsy in our hospital between January 2021 and December 2023. According to the pathological results, we divided the patients into a CSPCa (n = 44) and a non-CSPCa group (n = 283), collected their clinical and imaging data, and subjected them to statistical analysis.
The age, tPSA level, PSAD and PI-RADS score were significantly higher, while the free PSA (fPSA) level, f/tPSA ratio and prostate volume remarkably lower in the CSPCa than in the non-CSPCa group (P<0.05). The areas under the curve (AUCs) of PSAD, PI-RADS score and their combination were 0.772, 0.730 and 0.801, with sensitivities of 63.63%, 70.45% and 72.73%, and specificities of 84.10%, 75.62% and 83.75%, respectively (P<0.01). With PSAD 0.2 μg/(ml·cm3) as the best cut-off value and based on the PI-RADS scores, the patients were divided into two groups for analysis. In the patients with PI-RADS scores 2 and 5, the AUCs were 0.534 and 0.643, with sensitivities of 16.67% and 63.64%, and specificities of 85.14% and 64.29%, with no statistically significant differences (P= 0.784, P= 0.228), and in those with PI-RADS scores 3 and 4, the AUCs were 0.794 and 0.843, with sensitivities of 57.14% and 80.00%, and specificities of 87.14% and 81.82%, with statistically significant differences (P= 0.009, P<0.001).
PI-RADS v2.1 score combined with PSAD can effectively improve the diagnostic efficiency of CSPCa in the PSA grey zone by MRI-TRUS cognitive fusion-guided transperineal targeted prostate biopsy and serve as a guide for selection of prostate biopsy.
通过磁共振成像-经直肠超声（MRI-TRUS）认知融合引导下经会阴靶向前列腺穿刺活检，评估前列腺影像报告和数据系统第2.1版（PI-RADS v2.1）评分联合前列腺特异抗原密度（PSAD）在前列腺特异特异抗原特异抗原（PSA）灰色区间临床显著性前列腺癌（CSPCa）诊断中的价值。
本回顾性研究纳入了2021年1月至2023年12月期间在我院接受MRI-TRUS认知融合引导下经会阴靶向前列腺穿刺活检的327例总PSA（tPSA）水平为4-10μg/L的男性患者。根据病理结果，将患者分为CSPCa组（n = 44）和非CSPCa组（n = 283），收集其临床和影像数据，并进行统计分析。
CSPCa组患者的年龄、tPSA水平、PSAD和PI-RADS评分显著高于非CSPCa组，而游离PSA（fPSA）水平、f/tPSA比值和前列腺体积显著低于非CSPCa组（P<0.05）。PSAD、PI-RADS评分及其联合的曲线下面积（AUC）分别为0.772、0.730和0.801，敏感度分别为63.63%、70.45%和72.73%，特异度分别为84.10%、75.62%和83.75%（P<0.0）。以PSAD 0.2μg/(ml·cm³)为最佳截断值，并基于PI-RADS评分将患者分为两组进行分析。在PI-RADS评分为2和5的患者中，AUC分别为0.534和0.643，敏感度分别为16.67%和63.64%，特异度分别为85.14%和64.29%，差异无统计学意义（P = 0.784，P = 0.228）；在PI-RADS评分为3和4的患者中，AUC分别为0.794和0.843，敏感度分别为57.14%和80.00%，特异度分别为87.14%和81.82%，差异有统计学意义（P = 0.009，P<0.001）。
PI-RADS v2.1评分联合PSAD可通过MRI-TRUS认知融合引导下经会阴靶向前列腺穿刺活检有效提高PSA灰色区间CSPCa的诊断效率，并为前列腺穿刺活检的选择提供指导。
