Combination of PSA density and MLR improves diagnostic accuracy of prostate cancer

Feng Guo¹Aerken Maolake^2*Zecheng Ni¹Xun Li¹Bide Liu¹Zetian Tang¹Zhenfeng Shi¹Jiuzhi Li¹

• ¹People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang Uyghur Region, China
• ²Roswell Park Comprehensive Cancer Center, University at Buffalo, Buffalo, United States

Prostate-specific antigen (PSA) is used to screen for prostate cancer for decades. However, PSA has poor specificity in prostate cancer screening within the 4.0-to 10.0-ng/mL range. This study aimed to develop a new prediction model for PCa in patients with a PSA level of 2.5-20 ng/mL.The clinical data of eighty patients with PSA 4-22ng/ml from 2016 to 2022 were selected for retrospective analysis. Prostate volume was estimated by suprapubic ultrasonography. PSA-and the inflammatory markers like neutrophils to lymphocytes ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) in peripheral blood were analyyzed to assessed the value of them in PCa. The diagnostic performance of PSA, PSA density (PSAD) and inflammatory markers were estimated by ROC curve. The areas under the ROC curve for f/t PSA, PV, PSAD, MLR， NLR and PLR for predicting PCa in patients with a PSA level of 4.0-22.0 ng/mL were 0.7375, 0.7774, 0.8294, 0.5945, 0.5571,and 0.5437, respectively. The PSAD performed better than f/t PSA and PV in diagnosis of PCa. The specificity of PSAD was higher than that of f/tPSA when tPSA was in gray zone (between 4ng/mL～10ng/mL).The area under the curve (AUC) increased when PSAD was combined with MLR in patients with PSA 4-10ng/ml and patients with PSA 10-22ng/ml and the positive predictive value were 81.81% and 90.91% respectively (P=0.0008 and P=0.0002). PSAD has a modrate diagnositic value for PCa detection.The combination of PSAD and MLR could improve diagnostic accuracy in PCa diagnosis.