MRI-based PSA density and PSA density of the transitional zone compared with PSA alone: correlation with prostate cancer Gleason score.
OBJECTIVE
The tumor Gleason score is an important prognostic factor in prostate cancer (PCA). This retrospective study analyzes whether serum prostate-specific antigen (PSA), or magnetic resonance imaging (MRI)-based PSA density of the entire prostate (PSAD) or the prostatic transitional zone (PSAT) distinguishes between PCA of Gleason scores 6 or lower (G6-) and 7 or higher (G7+).


METHODS
Total prostate and transitional zone volumes were planimetrically determined in axial, T2-weighted fast spin echo (FSE) MRI images of the prostate in 61 patients with previously untreated PCA. Automated standardized microparticle enzyme immuno-assay (EIAs) measured PSA.


RESULTS
Thirty patients had G6- and 31 patients had G7+. PSA values ranged from 1.0 to 57.2 ng/mL. Assignment to G6- or G7+, respectively, was correct in 49 of 61 (80%) cases (odds ratio [OR], 17.1; 95% confidence interval [CI], 4.8-61.5) for PSA above the optimal cutoff level of 10.35 ng/mL, 48 cases (79%; OR, 13.7; 95% CI, 4.0-46.8) for PSAD above the optimal cutoff level of 0.23 ng/mL/cm, and 45 cases (74%; OR, 6.9; 95% CI, 2.2-21.3) for PSAT above the optimal cutoff level of 0.38 ng/mL/cm (no significant differences, McNemar test).


CONCLUSIONS
In patients with biopsy-proven PCA, serum PSA level alone and MRI-based PSAD and PSAT help distinguish between G6- and G7+. PSAD and PSAT do not improve the level of confidence at which this discrimination is made.
Graser
Anno
A
Department of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany. anno.graser@med.uni-muenchen.de
Heuck
Andreas F
AF
Sommer
Bernhard
B
Massmann
Joerg
J
Reiser
Maximilian F
MF
Mueller-Lisse
Ullrich G
UG
D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000737:chemistry* / Q000473:pathology*; D012189:Retrospective Studies
D017430:Prostate-Specific Antigen