Diagnostic Value of Combined PI-RADS v2.1 and PSAD in Detecting Clinically Significant Prostate Cancer in the Gray Zone of PSA: A Dual-Center Study

Motivation: It is crucial to improve the accuracy of detection of clinically significant prostate cancer (csPCa) within the PSA gray zone. Goal(s): To combine PI-RADS v2.1 with prostate-specific antigen density(PSAD) derivatives to improve the predictive value of csPCa in the PSA gray zone. Approach: Based on a dual-center study, logistic regression was used to analyze the predictive value of the multi-parameter combination on csPCa in the training group, the receiver operating characteristic curve(ROC) curves were used to evaluate the diagnostic performance, and conducting external validation. Results: The area under curve (AUC) of combining of PI-RADS v2.1 and PSAD was the highest for predicting csPCa. Impact: The dual-center study demonstrates combining of PI-RADS v2.1 and PSAD improved the predictive performance of csPCa in the PSA gray zone, and grouping PSAD with PI-RADS risk stratification can have more direct clinical applications.