Likelihood of prostate cancer based on prostate-specific antigen density by MRI: retrospective analysis.
OBJECTIVE
As a screening test for prostate cancer (PCA), prostate-specific antigen (PSA) may induce unnecessary prostate biopsy in patients with PSA 4.1-10.0 ng/ml. PCA detection may be delayed in patients with PSA < or =4.0 ng/ml. MRI-based PSA density of the prostate (PSAD) and of the prostatic transitional zone (PSAT) could improve differentiation of PCA and benign prostatic hyperplasia.


METHODS
Total prostate and transitional zone volumes were planimetrically determined in axial, T2-weighted fast spin echo MR images of the prostate. Serum PSA concentration was measured with an automated standardized microparticle enzyme immune assay. PSAD and PSAT were calculated in 17 patients with clinically significant PCA and 42 patients with benign prostatic hypertrophy (BPH) (66 +/- 6 versus 64 +/- 8 years, p = 0.2410, t test) who had PSA levels < or =10.0 ng/ml.


RESULTS
For differentiation of BPH and PCA, PSA alone above the optimal cutoff level of 4.2 ng/ml showed an odds ratio for PCA of 6.7 (95% confidence interval [CI], 1.9-23.2). PSAD showed an odds ratio for PCA of 71.3 (95% CI, 11.8-430.9) above the optimal cutoff level of 0.07 ng/ml/cc. PSAT demonstrated an odds ratio for PCA of 320.0 (95% CI, 27.1-3781.4) above the optimal cutoff level of 0.15 ng/ml/cc.


CONCLUSIONS
In patients with PSA < or =10.0 ng/ml, MRI-based PSAD and PSAT appear to improve differentiation of prostate cancer and BPH and are feasible to reduce the frequency of unnecessary prostate biopsy.
Mueller-Lisse
Ullrich G
UG
Department of Radiology, Klinikum Grosshadern, University of Munich, Germany. m-lisse@ikra.med.uni-muenchen.de
Mueller-Lisse
Ulrike L
UL
Haller
Steffen
S
Schneede
Peter
P
Scheidler
Juergen E
JE
Schmeller
Nicolaus
N
Hofstetter
Alfons G
AG
Reiser
Maximilian F
MF
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000175:diagnosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012984:Software
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen