Prostate cancer diagnostics has made significant progress in recent years with the combination of multiparametric magnetic resonance imaging (mpMRI) and blood biomarkers such as PSA. One particularly useful parameter is PSA density (PSAd), which relates PSA level to prostate volume, offering a more accurate indication of cancer risk.
METHODOLOGY
In this large multicenter study, our researchers analyzed the predictive value of PSAd for clinically significant prostate cancer. The purpose of the study was to evaluate the differences in diagnostic efficacy of PSAd according to the site of the suspected lesion detected by mpMRI. Over two thousand men with positive mpMRI (lesions with PI-RADS score ≥ 3) were included, all of whom underwent targeted systematic prostate biopsies.
RESULTS
I risultati hanno mostrato che la combinazione tra PSAd e sede della lesione è particolarmente utile per interpretare correttamente le lesioni PI-RADS 3, considerate “intermedie” dal punto di vista del sospetto oncologico. In questo gruppo, il rischio di tumore clinicamente significativo era molto basso (<10%) quando il PSAd era inferiore a 0,05 ng/ml/ml per le lesioni in zona periferica e inferiore a 0,13 ng/ml/ml per quelle in zona di transizione. Al contrario, quando il PSAd superava queste soglie, il rischio aumentava in modo rilevante, giustificando l’indicazione alla biopsia.
For the most suspicious lesions, i.e., PI-RADS 4 or higher, the risk still remained high (≥20%) regardless of PSAd and site, making biopsy always necessary.
In conclusion, the study highlights that the interpretation of PSAd should not be uniform, but should take into account the site of the intraprostatic lesion. This targeted approach can improve the results of prostate biopsies
Quarta, L., Stabile, A., Pellegrino, F. et al. Tailored use of PSA density according to multiparametric MRI index lesion location: results of a large, multi-institutional series. Prostate Cancer Prostatic Dis (2025).
