Clinical and prostate multiparametric magnetic resonance imaging findings as predictors of general and clinically significant prostate cancer risk:A retrospective single-center study

Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.