.: ORİJİNAL ARAŞTIRMA
Assessing the Diagnostic Value of PSA Derivatives and MpMRI in Prostate Cancer Detection: A Retrospective Study
Prostat Kanseri Tespitinde PSA Türevlerinin ve MpMRI'nin Tanısal Değerinin Değerlendirilmesi: Retrospektif Çalışma
J Reconstr Urol. 2025;15(1):8-13
doi: 10.5336/urology.2024-107842
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: To examine the correlation between free prostate-specific antigen (fPSA)/total prostate-specific antigen (tPSA) ratios, multiparametric magnetic resonance imaging (MpMRI) findings, and pathological results in patients with PSA levels ranging from 4 to 10 ng/dl, which is considered the grey zone. Material and Methods: Mp-MRI was performed in 101 patients between 2020 and 2022. Transrectal ultrasonography-guided prostate biopsy was performed in patients with PSA values between 4-10 ng/dl. Patients were categorized into 2 groups based on their pathology Results: malignant (group 1) and benign (group 2). The fPSA/tPSA ratios, Prostate Imaging Reporting and Data System (PI-RADS) scores, and International Society of Urological Pathology (ISUP) scores of patients in the malignant group were recorded. Results: Pathological analysis of 101 patients yielded following Results: 31.7% (31 individuals) were diagnosed with cancer, 3% (3 cases) presented with atypical small acinar proliferation, and 66.3% (67 patients) were determined to have benign conditions. The mean fPSA/tPSA ratio of patients was lower in group 1 (group 1: 0.13±0.06, group 2: 0.22±0.08, p=0.001). The fPSA/tPSA ratio was significantly lower in PI-RADS-4 and 5 compared to PI-RADS-3. A significant correlation was found between PIRADS scores and cancer detection rates (p=0.003). Conclusion: It is important to calculate fPSA/PSA ratio and decide to perform biopsy in patients with PSA values between 4-10 ng/dl. As PI-RADS scores increased and free/total PSA ratios decreased, the frequency of cancer detection increased. This study demonstrates the importance of PSA derivatives in diagnostic processes.
Keywords: Prostate neoplasm; prostate specific antigen; multiparametric magnetic resonance imaging
Objective: To examine the correlation between free prostate-specific antigen (fPSA)/total prostate-specific antigen (tPSA) ratios, multiparametric magnetic resonance imaging (MpMRI) findings, and pathological results in patients with PSA levels ranging from 4 to 10 ng/dl, which is considered the grey zone. Material and Methods: Mp-MRI was performed in 101 patients between 2020 and 2022. Transrectal ultrasonography-guided prostate biopsy was performed in patients with PSA values between 4-10 ng/dl. Patients were categorized into 2 groups based on their pathology Results: malignant (group 1) and benign (group 2). The fPSA/tPSA ratios, Prostate Imaging Reporting and Data System (PI-RADS) scores, and International Society of Urological Pathology (ISUP) scores of patients in the malignant group were recorded. Results: Pathological analysis of 101 patients yielded following Results: 31.7% (31 individuals) were diagnosed with cancer, 3% (3 cases) presented with atypical small acinar proliferation, and 66.3% (67 patients) were determined to have benign conditions. The mean fPSA/tPSA ratio of patients was lower in group 1 (group 1: 0.13±0.06, group 2: 0.22±0.08, p=0.001). The fPSA/tPSA ratio was significantly lower in PI-RADS-4 and 5 compared to PI-RADS-3. A significant correlation was found between PIRADS scores and cancer detection rates (p=0.003). Conclusion: It is important to calculate fPSA/PSA ratio and decide to perform biopsy in patients with PSA values between 4-10 ng/dl. As PI-RADS scores increased and free/total PSA ratios decreased, the frequency of cancer detection increased. This study demonstrates the importance of PSA derivatives in diagnostic processes.
Keywords: Prostate neoplasm; prostate specific antigen; multiparametric magnetic resonance imaging
ÖZET
Amaç: Gri son olarak kabul edilen 4-10 ng/dl arasında değişen prostat spesifik antijeni (PSA) düzeyleri olan hastalarda serbest [free (fPSA)]/total prostat spesifik antijen (tPSA) oranları, multiparametrik manyetik rezonans görüntüleme [magnetic resonance imaging (MpMRI)] bulguları ve patolojik sonuçlar arasındaki korelasyonu incelemek. Gereç ve Yöntemler: 2020-2022 yılları arasında 101 hastaya Mp-MRI uygulandı. PSA değerleri 4-10 ng/dl arasında olan hastalara transrektal ultrasonografi eşliğinde prostat biyopsisi yapıldı. Hastalar patoloji sonuçlarına göre 2 gruba ayrıldı: malign (grup 1) ve benign (grup 2). Malign gruptaki hastaların fPSA/tPSA oranları, Prostat Görüntüleme Raporlama ve Veri Sistemi [Prostate Imaging Reporting and Data System (PI-RADS)] skorları ve Uluslararası Ürolojik Patoloji Derneği [International Association of Urological Pathology (ISUP)] skorları kaydedildi. Bulgular: 101 hastanın patolojik analizi aşağıdaki sonuçları vermiştir: %31,7'sine (31 kişi) kanser tanısı konuldu, %3'ü (3 olgu) atipik küçük asiner proliferasyon (atypical small acinar proliferation) ile başvurdu ve %66,3'ünün (67 hasta) benign durumları olduğu belirlendi. Hastaların ortalama fPSA/tPSA oranı grup 1'de daha düşüktü (grup 1: 0,13±0,06, grup 2: 0,22±0,08, p=0,001). PI-RADS-4 ve 5'te fPSA/tPSA oranı PI-RADS-3'e kıyasla anlamlı derecede düşüktü. PI-RADS skorları ile kanser tespit oranları arasında anlamlı bir korelasyon bulundu (p=0,003). Sonuç: PSA değerleri 4-10 ng/dl arasında olan hastalarda fPSA/PSA oranının hesaplanması ve biyopsi yapılmasına karar verilmesi önemlidir. PI-RADS skorları arttıkça ve sPSA/tPSA oranları azaldıkça kanser tespit sıklığı artmaktadır. Bu çalışma, PSA türevlerinin tanısal süreçlerdeki önemini göstermektedir.
Anahtar Kelimeler: Prostat neoplazmı; prostat spesifik antijeni; multiparametrik manyetik rezonans görüntüleme
Amaç: Gri son olarak kabul edilen 4-10 ng/dl arasında değişen prostat spesifik antijeni (PSA) düzeyleri olan hastalarda serbest [free (fPSA)]/total prostat spesifik antijen (tPSA) oranları, multiparametrik manyetik rezonans görüntüleme [magnetic resonance imaging (MpMRI)] bulguları ve patolojik sonuçlar arasındaki korelasyonu incelemek. Gereç ve Yöntemler: 2020-2022 yılları arasında 101 hastaya Mp-MRI uygulandı. PSA değerleri 4-10 ng/dl arasında olan hastalara transrektal ultrasonografi eşliğinde prostat biyopsisi yapıldı. Hastalar patoloji sonuçlarına göre 2 gruba ayrıldı: malign (grup 1) ve benign (grup 2). Malign gruptaki hastaların fPSA/tPSA oranları, Prostat Görüntüleme Raporlama ve Veri Sistemi [Prostate Imaging Reporting and Data System (PI-RADS)] skorları ve Uluslararası Ürolojik Patoloji Derneği [International Association of Urological Pathology (ISUP)] skorları kaydedildi. Bulgular: 101 hastanın patolojik analizi aşağıdaki sonuçları vermiştir: %31,7'sine (31 kişi) kanser tanısı konuldu, %3'ü (3 olgu) atipik küçük asiner proliferasyon (atypical small acinar proliferation) ile başvurdu ve %66,3'ünün (67 hasta) benign durumları olduğu belirlendi. Hastaların ortalama fPSA/tPSA oranı grup 1'de daha düşüktü (grup 1: 0,13±0,06, grup 2: 0,22±0,08, p=0,001). PI-RADS-4 ve 5'te fPSA/tPSA oranı PI-RADS-3'e kıyasla anlamlı derecede düşüktü. PI-RADS skorları ile kanser tespit oranları arasında anlamlı bir korelasyon bulundu (p=0,003). Sonuç: PSA değerleri 4-10 ng/dl arasında olan hastalarda fPSA/PSA oranının hesaplanması ve biyopsi yapılmasına karar verilmesi önemlidir. PI-RADS skorları arttıkça ve sPSA/tPSA oranları azaldıkça kanser tespit sıklığı artmaktadır. Bu çalışma, PSA türevlerinin tanısal süreçlerdeki önemini göstermektedir.
Anahtar Kelimeler: Prostat neoplazmı; prostat spesifik antijeni; multiparametrik manyetik rezonans görüntüleme
REFERANSLAR:
- World Health Organization: Cancer Today [Internet]. Data visualization tools for exploring the global cancer burden in 2022. © IARC 1965-2025 [Cited: December 23, 2024] Available from: [Link]
- Partin AW, Carter HB, Chan DW, Epstein JI, Oesterling JE, Rock RC, et al. Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. J Urol. 1990;143(4):747-52. [Crossref] [PubMed]
- Westphalen AC, Rosenkrantz AB. Prostate imaging reporting and data system (PI-RADS): reflections on early experience with a standardized interpretation scheme for multiparametric prostate MRI. AJR Am J Roentgenol. 2014;202(1):121-3. [Crossref] [PubMed]
- Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol. 2019;76(3):340-51. [Crossref] [PubMed]
- Demirel HC, Davis JW. Multiparametric magnetic resonance imaging: overview of the technique, clinical applications in prostate biopsy and future directions. Turk J Urol. 2018;44(2):93-102. [Crossref] [PubMed] [PMC]
- Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al; ERSPC Investigators. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med. 2012;366(11):981-90. Erratum in: N Engl J Med. 2012;366(22):2137. [Crossref] [PubMed] [PMC]
- Klotz L, Chin J, Black PC, Finelli A, Anidjar M, Bladou F, et al. Comparison of multiparametric magnetic resonance imaging-targeted biopsy with systematic transrectal ultrasonography biopsy for biopsy-naive men at risk for prostate cancer: a phase 3 randomized clinical trial. JAMA Oncol. 2021;7(4):534-42. Erratum in: JAMA Oncol. 2021;7(4):639. Erratum in: JAMA Oncol. 2021;7(7):1074. [Crossref] [PubMed] [PMC]
- Albertsen PC. Screening for prostate cancer with prostate-specific antigen: the journey continues. Eur Urol. 2023;83(2):110-1. [Crossref] [PubMed]
- Feigl P, Blumenstein B, Thompson I, Crowley J, Wolf M, Kramer BS, et al. Design of the Prostate Cancer Prevention Trial (PCPT). Control Clin Trials. 1995;16(3):150-63. [Crossref] [PubMed]
- Van Cangh PJ, De Nayer P, De Vischer L, Sauvage P, Tombal B, Lorge F, et al. Free to total prostate-specific antigen (PSA) ratio improves the discrimination between prostate cancer and benign prostatic hyperplasia (BPH) in the diagnostic gray zone of 1.8 to 10 ng/mL total PSA. Urology. 1996;48(6A Suppl):67-70. [Crossref] [PubMed]
- Christensson A, Björk T, Nilsson O, Dahlén U, Matikainen MT, Cockett AT, et al. Serum prostate specific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol. 1993;150(1):100-5. [Crossref] [PubMed]
- Catalona WJ, Southwick PC, Slawin KM, Partin AW, Brawer MK, Flanigan RC, et al. Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. Urology. 2000;56(2):255-60. [Crossref] [PubMed]
- Hofer C, Sauerstein P, Wolter C, Scholz M, Hartung R, Breul J. Value of free prostate-specific antigen (Hybritech Tandem-R) in symptomatic patients consulting the urologist. Urol Int. 2000;64(1):18-23. [Crossref] [PubMed]
- Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998;279(19):1542-7. [Crossref] [PubMed]
- Pelzer AE, Volgger H, Bektic J, Berger AP, Rehder P, Bartsch G, et al. The effect of percentage free prostate-specific antigen (PSA) level on the prostate cancer detection rate in a screening population with low PSA levels. BJU Int. 2005;96(7):995-8. [Crossref] [PubMed]
- Stroumbakis N, Cookson MS, Reuter VE, Fair WR. Clinical significance of repeat sextant biopsies in prostate cancer patients. Urology. 1997;49(3A Suppl):113-8. [Crossref] [PubMed]
- Roehrborn CG, Pickens GJ, Sanders JS. Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology. 1996;47(3):347-52. [Crossref] [PubMed]
- Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, et al. MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis. N Engl J Med. 2020;382(10):917-28. [Crossref] [PubMed] [PMC]
- Osses DF, van Asten JJ, Tijsterman JD. Cognitive-targeted versus magnetic resonance imaging-guided prostate biopsy in prostate cancer detection. Curr Urol. 2018;11(4):182-8. [Crossref] [PubMed] [PMC]
- Elwenspoek MMC, Sheppard AL, McInnes MDF, Merriel SWD, Rowe EWJ, Bryant RJ, et al. Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(8):e198427. [Crossref] [PubMed] [PMC]
- Elkhoury FF, Felker ER, Kwan L, Sisk AE, Delfin M, Natarajan S, et al. Comparison of targeted vs systematic prostate biopsy in men who are biopsy naive: the prospective assessment of image registration in the diagnosis of prostate cancer (PAIREDCAP) study. JAMA Surg. 2019;154(9):811-8. [Crossref] [PubMed] [PMC]
- Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, et al. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol. 2015;68(6):1045-53. [Crossref] [PubMed]
- Oerther B, Engel H, Bamberg F, Sigle A, Gratzke C, Benndorf M. Cancer detection rates of the PI-RADSv2.1 assessment categories: systematic review and meta-analysis on lesion level and patient level. Prostate Cancer Prostatic Dis. 2022;25(2):256-63. [Crossref] [PubMed] [PMC]
.: İşlem Listesi