Diagnostic accuracy of MRI-based PSA density for detection of prostate cancer among the Thai population

Abstract

Background: The PSAD calculating by the serum PSA level divided by prostate volume had more specificity and accuracy than the serum PSA level for detection of prostate cancer. Methods: MRI examinations of 319 patients who had suspected prostate cancer between January 2014 and December 2019 were retrospectively reviewed. Prostate volumes were measured by MRI images and PSAD values were calculated. The accuracy and optimal cutoff points of MRI-based PSAD were evaluated using receiver operating characteristic curves (ROC curves). Correlations between the MRI-based PSAD and Gleason scores were also analyzed to predict prognosis of prostate cancer. Results: Overall, of 154 patients were included in this study, 59 patients (38.31%) were diagnosed with prostate cancer. The optimal cutoff point of PSAD was 0.16 (81.40% sensitivity, 54.70% specificity, 52.70% PPV, 82.50% NPV), and the AUC was 0.680 (95% CI: 0.609–0.751). In subgroup analyses, the optimal cutoff point of PSAD in patients with serum PSA 4–10 ng/ml was 0.16 (61.10% sensitivity, 76.00% specificity) and for > 10 ng/ml was 0.30 (68.30% sensitivity, 64.30% specificity). Furthermore, there was a statistically significant correlation between PSAD and Gleason scores (p-value 0.014). Conclusions: The optimal cutoff point of MRI-based PSAD was 0.16 which was relatively different from international consensus.