The effects of prostate volume and PI-RADS category on optimal PSA-density thresholds for biopsy decision-making

作者：Selahattin Durmaz, Shun-Chin Jim Wu, Kang‐Lung Lee, Amreen Shakur, Iztok Caglič, Tristan Barrett · 发表于：European Radiology · 年份：2026 · DOI：10.1007/s00330-025-12272-y · 被引用次数：8 · 研究领域：Prostate Cancer Diagnosis and Treatment、Advanced Radiotherapy Techniques、Prostate Cancer Treatment and Research

OBJECTIVES: To evaluate the effect of prostate volume on the risk of clinically significant prostate cancer (csPCa) across a range of PSA-density (PSAd) values, and to explore the relationship between PI-RADS category and PSAd in predicting csPCa. MATERIALS AND METHODS: We retrospectively analyzed 2190 patients undergoing mpMRI for suspected PCa. Patients were classified as csPCa and clinically insignificant (negative and insignificant PCa). Logistic regression was performed to assess the csPCa risk at different PSAd cut-offs across different prostate volume subgroups (< 40, 40-60, 60-80, > 80 mL) and PI-RADS categories. The effect of prostate volume on PSAd performance was evaluated using ROC analysis. To assess robustness, we performed an 80:20 split-sample internal validation. RESULTS: 747/2190 (34.1%) patients had PCa, including 571 (26.1%) with csPCa. Regardless of PSAd, csPCa risk exceeded 30% for PI-RADS 4 and 50% for PI-RADS 5. At a 10% csPCa risk threshold, the optimal PSAd cut-offs were 0.20 ng/mL² for PI-RADS 1-2 and 0.12 ng/mL² for PI-RADS 3. Logistic regression showed a significant inverse correlation between prostate volume and csPCa probability. Notably, 79% of csPCa patients with prostate volume ≤ 40 mL had a PSAd ≥ 0.15 ng/mL², compared to only 22.4% with volumes ≥ 60 mL. PSAd performed significantly worse for larger glands (≥ 60 mL), with AUCs of 0.70 versus 0.84 (≤ 40 mL) and 0.82 (40-60 mL), both p < 0.001. CONCLUSION: The optimal PSAd cut-offs for guiding...