ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Imaging and Image-directed Interventions
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1602412
This article is part of the Research TopicMethods and Applications of Tumour Metabolic Imaging in the Preclinical and Clinical SettingView all 8 articles
PI-RADSv2.1 Combined with PSA Density for Optimizing Prostate Biopsy Decisions A Retrospective Analysis
Provisionally accepted
- 1Department of Radiology, First People's Hospital of Yibin, Sichuan, China
- 2First People's Hospital of Yibin, Sichuan, China
- 3Beijing, Philips Healthcare (China), Shanghai, China
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This study aimed to explore the clinical utility of the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) combined with prostate-specific antigen density (PSAD) to guide prostate biopsy, aiming to improve biopsy positivity rates and reduce unnecessary procedures. A retrospective analysis was conducted on data from 462 patients (age 44–89 years) who underwent prostate biopsy. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for clinically significant prostate cancer (csPCa). A diagnostic model was established to determine biopsy indications. Diagnostic performance was evaluated by receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, positive predictive value, negative predictive value, biopsy avoidance rate, and missed diagnosis rate. Multivariate logistic regression revealed PI-RADS v2.1 score (P< 0.001; OR = 9.779; 95% confidence interval (CI) = 5.849-16.349] and PSAD [P <0.001; OR = 6.128; 95% CI = 2.292-16.386] were independent risk factors for csPCa. The combination of PI-RADS v2.1 and PSAD achieved optimal diagnostic performance (area under the curve [AUC]= 0.966; sensitivity= 92.4%; specificity= 91.6%). The optimal threshold for csPCa diagnosis was PI-RADS v2.1 score ≥ 4 and PSAD ≥ 0.30 ng/(mL·cm³). No csPCa was detected among patients with a PI-RADS score < 3 and PSAD < 0.30 ng/(mL·cm³), or with a PI-RADS score of 3 and PSAD <0.15 ng/(mL·cm³), suggesting biopsy avoidance in these cases. Based on these findings, the following biopsy indications are recommended: (1) For patients with PI-RADS scores of 1-2, biopsy can be avoided if PSAD is < 0.30 ng/(mL·cm³), whereas biopsy is recommended if PSAD is ≥ 0.30 ng/(mL·cm³). (2) For patients with a PI-RADS score of 3, biopsy can be avoided if PSAD is < 0.15 ng/(mL·cm³), but it is recommended if PSAD is ≥ 0.15 ng/(mL·cm³). (3) Patients with a PI-RADS score of 4 are recommended for biopsy in all cases. (4) For patients with a PI-RADS score of 5, biopsy is recommended if PSAD is < 2.00 ng/(mL·cm³), but empirical initiation of treatment without biopsy may be considered if PSAD ≥ 2.00 ng/(mL·cm³), subject to ethics committee approval. Using these criteria, 40% (186/462) of patients could potentially avoid prostate biopsy.
Keywords: Biopsy, indications, Multiparametric magnetic resonance imaging, prostate cancer, Prostate imaging reporting and data system, Prostate-Specific Antigen
Received: 29 Mar 2025; Accepted: 17 Jun 2025.
Copyright: © 2025 Li, Wang, Wang, Qi, Liu, He, Zhang, Zhu and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yunfu Zeng, Department of Radiology, First People's Hospital of Yibin, Sichuan, China
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