Evaluation of the association between prostate-specific antigen density and systematic prostate biopsy pathological results

Abstract

Objective:

To evaluate the correlation between pre-biopsy prostate-specific antigen (PSA) density (PSA-d) and International Society of Urological Pathology (ISUP) grade groups obtained from systematic transrectal prostate biopsies (TRUS-B). The secondary objective was to compare the diagnostic accuracy of PSA-d and PSA for prostate cancer (PCa) detection.

Methods:

A retrospective study was conducted on 1094 patients with PSA levels between 2.5 and 25 ng/ml who underwent TRUS-B between 2016 and 2024. Patients were classified into four groups based on PSA-d levels: <0.10, 0.10–0.14, 0.15–0.20, and >0.20 ng/ml/cc. Detection of the ISUP grade for each group was obtained and compared among the groups. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC).

Results:

PCa detection rates increased with PSA-d, from 14.2% (<0.10 ng/ml/cc) to 85.9% (>0.20 ng/ml/cc), while clinically significant PCa rates ranged from 5.9% to 68.4% across the same PSA-d levels. Higher PSA-d levels were significantly associated with elevated ISUP grade groups. However, for ISUP grade group 1, the only significant difference was between patients with PSA-d <0.10 ng/ml/cc and those with PSA-d ⩾0.10 ng/ml/cc. PSA-d demonstrated superior diagnostic accuracy (AUC = 0.821) compared with PSA (AUC = 0.654).

Conclusion:

PSA-d is a reliable marker for predicting PCa aggressiveness and has better diagnostic accuracy than PSA. Incorporating PSA-d into clinical decision-making may enhance the detection of clinically significant PCa, particularly in resource-limited settings where advanced imaging modalities are unavailable.