Assessing the Diagnostic Value of PSA Derivatives and MpMRI in Prostate Cancer Detection: A Retrospective Study

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.