The Diagnostic Value Of Multiparametric Magnetic Resonance Imaging PI-RADS V2.1 Score Combined With PSA Derivative Indicators In Prostate Cancer With PSA Levels Of 4～20 Ng/ml

Objective:The aim of this study is to explore the diagnostic value of multiparametric magnetic resonance imaging technique PI-RADS v2.1 score combined with PSA derivative indicators in prostate cancer with PSA levels of 4～20 ng/ml.Methods:Through retrospective analysis,we collected data of patients who received prostate mp MRI examination and prostate biopsy for prostate disease in the Department of Urology of Henan Provincial People’s Hospital from January 2019 to November 2022.PI-RADS v2.1 score was performed on the mp MRI images of all patients.Clinical data of patients were collected and analyzed,including age,tPSA,f PSA,f/tPSA,PV(prostate volume),PSAD(prostate specific antigen density)and PI-RADS v2.1 score.Patients were divided into two subgroups based on serum PSA level,namely,PSA 4 ～ 10 ng/ml subgroup(gray zone group)and PSA 10 ～ 20 ng/ml subgroup.According to the pathological results of prostate biopsy,the patients were divided into prostate cancer group(PCa group)and non-prostate cancer group(n PCa group).The independent sample t-test and the rank-sum test was used to compare the differences of each indicators(age,tPSA,f PSA,f/tPSA,PV,PSAD and PI-RADS v2.1 score)between prostate cancer group and non-prostate cancer group in differentPSA subgroups.To compare the difference of positive rate of prostate puncture among different PI-RADS v2.1 scores in differentPSA subgroups.Binary logistic regression model was used to perform univariate and multivariate analysis in differentPSA subgroups to determine the risk factors and independent predictors of prostate cancer in differentPSA subgroups.We evaluated the diagnostic efficacy of PI-RADS v2.1 score and the combination of PI-RADS v2.1 score and PSA derivative indicators for prostate cancer in differentPSA subgroups by the receiver operating characteristics(ROC)curve.The Youden index and area under the curve(AUC)was calculated to obtain the optimal cutoff value for the diagnosis of prostate cancer and to calculate the sensitivity and specificity.The Delong test was used to compare the difference of AUC of each indicators.Results:A total of 230 patients were included in this study.122 patients were in the PSA 4 ～ 10 ng/ml subgroup,including 33 prostate cancer patients and 89 non-prostate cancer patients,with a positive puncture rate of 27%.The PSA 10～20 ng/ml subgroup had 108 patients,including 43 prostate cancer patients and 65 non-prostate cancer patients,with a positive puncture rate of 40%.In the PSA 4～10 ng/ml subgroup,the differences of f/tPSA,PV,PSAD and PI-RADS v2.1 score between PCa group and n PCa group were statistically significant(P < 0.05).The f/tPSA and PV were smaller in PCa group than those in n PCa group.PSAD and PI-RADS v2.1 score were higher in PCa group than those in n PCa group.However,there were no significant differences in age,f PSA and tPSA in two groups(P>0.05).The results of binary logistic regression analysis showed thatPSAD(OR=621.719,P<0.05)and PI-RADS v2.1 score(OR=2.718,P<0.05)were both independent predictors of prostate cancer in the PSA gray zone.The results of ROC curve analysis showed that when PSAD and PI-RADS v2.1 score were 0.21 ng/m L2 and 4,the area under the curve of PSAD and PI-RADS v2.1 score for the diagnosis of prostate cancer in the PSA gray zone were 0.727(95%CI:0.621-0.833,P < 0.001)and0.791(95%CI:0.692-0.890,P < 0.001),respectively.The AUC of PI-RADS v2.1 score combined with PSAD was 0.837(95%CI:0.748-0.926,P<0.001),which was higher than that of PSAD(Z=2.299,P<0.05),and the difference was statistically significant.In the PSA 10～20 ng/ml subgroup,the differences of f PSA,f/tPSA,PV,PSAD and PI-RADS v2.1score between PCa group and n PCa group were statistically significant(P<0.05).The f PSA,f/tPSA and PV were smaller in PCa group than those in n PCa group.PSAD and PI-RADS v2.1 score were higher in PCa group than those in n PCa group.However,there were no significant differences in age and tPSA in two groups(P>0.05).The results of binary logistic regression analysis showed thatPSAD(OR=65.329,P<0.05)and PI-RADS v2.1 score(OR=2.655,P<0.05)both were confirmed as independent predictors of prostate cancer.The results of ROC curve analysis showed that when PSAD and PI-RADS v2.1 score were0.38 ng/m L2 and 4,the area under the curve of PSAD and PI-RADS v2.1 score for the diagnosis of prostate cancer were 0.798(95%CI:0.712-0.884,P < 0.001)and 0.767(95%CI:0.672-0.861,P < 0.001),respectively.The AUC of PI-RADS v2.1 score combined with PSAD was 0.856(95%CI:0.779-0.934,P<0.001),which was not higher than that of PI-RADS v2.1 score(Z=1.889,P>0.05)or PSAD(Z=1.889,P>0.05).Conclusion:1.In patients with a total PSA of 4～20 ng/ml,both PSAD and PI-RADS v2.1 score were independent predictors of prostate cancer.2.For patients with a total PSA of 4～20 ng/ml,the positive rate of prostate puncture is different among different PI-RADS v2.1 scores,and the positive rate of prostate puncture increased with the increase of PI-RADS v2.1 scores.3.For patients with a total PSA of 4～20 ng/ml,PI-RADS v2.1 score can be used as a valid diagnostic method to diagnose prostate cancer,and the combination of PI-RADS v2.1 score and PSAD can improve the early diagnostic efficacy of prostate cancer and reduce unnecessary prostate biopsy.