Evaluating the Diagnostic Accuracy of MRI-Derived Prostate-Specific Antigen (PSA) Density in Prostate Cancer Detection and its Association With Tumor Aggressiveness

Introduction Prostate-specific antigen density (PSAD), calculated by dividing serum PSA levels by prostate volume, offers greater specificity and accuracy than serum PSA alone in detecting prostate cancer (PCa). This study aimed to evaluate the diagnostic performance of PSAD in PCa detection across different PSA levels and its correlation with Gleason scores. Methods This retrospective, single-center study reviewed data from 154 patients with suspected PCa who underwent prostate MRI between July 2021 and July 2023. Among these, 113 met the inclusion criteria, which required MRI-derived prostate volume measurements, serum PSA levels within three months of biopsy, and transperineal prostate biopsy results. PSAD was calculated by dividing serum PSA levels by prostate volume. Statistical analysis was conducted using STATA/SE 18.0 (StataCorp., College Station, TX, USA). Receiver operating characteristic (ROC) curves identified optimal PSAD cutoff values for PCa detection, and the relationship between PSAD and Gleason scores was analyzed. Results Of the 113 patients, 72 (63.72%) were diagnosed with PCa. The overall PSAD cutoff of 0.158 demonstrated a sensitivity of 73.61% and specificity of 92.68%, with an area under the curve (AUC) of 0.83 (95% CI: 0.77-0.90). For patients with PSA levels between 4-10 ng/ml, the optimal PSAD cutoff was 0.155 (sensitivity 65%, specificity 85.19%). For those with PSA levels >10 ng/ml, the cutoff was 0.175 (sensitivity 96.55%, specificity 66.67%). A significant correlation was found between PSAD and Gleason scores (p < 0.001), with higher PSAD values associated with more aggressive cancers. Conclusion PSAD demonstrates strong diagnostic accuracy for PCa and is significantly correlated with Gleason scores, suggesting its potential in assessing tumor aggressiveness and guiding clinical decisions.