title: Peripheral zone prostate cancer in patients with elevated PSA levels and low free-to-total PSA ratio: detection with MR imaging and MR spectroscopy.
abstract: OBJECTIVE
  To retrospectively assess the value of endorectal magnetic resonance (MR) imaging and MR spectroscopy combined with the free-to-total prostate-specific antigen (PSA) ratio for detecting prostate cancer in men with elevated PSA levels.
  
  
  METHODS
  The institutional review board approved the study, and all patients provided informed written consent. Endorectal MR imaging and MR spectroscopy were performed in 54 patients with PSA levels greater than 3 ng/mL but less than 15 ng/mL and free-to-total PSA ratio of less than 20%, followed by sextant biopsy in the peripheral zone. For each patient, MR imaging and MR spectroscopic findings, PSA level, and free-to-total PSA ratio were analyzed and compared with biopsy results and/or histopathologic tumor maps with regard to a sextant-modified distribution. The likelihood of cancer in each sextant according to MR and MR spectroscopic findings was graded independently on a scale of 1 (benign) to 5 (malignant). Detection accuracy and a multivariate logistic regression analysis were used to determine the most accurate combination of imaging, and clinical tests were used to detect prostate cancer according to the area under the receiver operating characteristic curve (AUC).
  
  
  RESULTS
  The model incorporating MR imaging, MR spectroscopy, and free-to-total PSA ratio (AUC = 97.5%) was significantly more accurate in predicting prostate cancer than models using MR imaging alone (AUC = 85.1%; P = .007), MR spectroscopy alone (AUC = 87.2%; P = .041), or MR imaging and free-to-total PSA ratio combined (AUC = 90.8%; P = .038).
  
  
  CONCLUSIONS
  MR and MR spectroscopy combined with free-to-total PSA ratio improves the predictive value for prostate cancer detection.
authors.affiliation: Department of Magnetic Resonance, Clínica Girona, Lorenzana 36, 17002 Girona, Spain. kvilanova@comg.cat
authors.forename: Joan C
authors.initials: JC
authors.lastname: Vilanova
authors.forename: Josep
authors.initials: J
authors.lastname: Comet
authors.forename: Carles
authors.initials: C
authors.lastname: Barceló-Vidal
authors.forename: Joaquim
authors.initials: J
authors.lastname: Barceló
authors.forename: Eugeni
authors.initials: E
authors.lastname: López-Bonet
authors.forename: Albert
authors.initials: A
authors.lastname: Maroto
authors.forename: Montse
authors.initials: M
authors.lastname: Arzoz
authors.forename: Angel
authors.initials: A
authors.lastname: Moreno
authors.forename: Joan
authors.initials: J
authors.lastname: Areal
mesh_terms: D000368:Aged; D019540:Area Under Curve; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen