Integrated prognostic value of PSA, Multiparametric magnetic resonance imaging, and Pathohistological markers in prostate cancer

INTRODUCTION Prostate cancer is a heterogeneous disease with a variable clinical course, so accurate preoperative risk assessment is crucial for optimal treatment decision-making. Prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mp MRI) with PI-RADS score, and the biopsy Gleason score are important parameters for preoperative evaluation. The aim of this study is to assess their integrated prognostic value in predicting positive surgical margins, peri neural invasion, lympho vascular invasion, and elevated postoperative PSA. METHODOLOGY We conducted a retrospective analysis of 29 patients with prostate cancer who underwent biopsy and radical prostatectomy at GOB “8th September” – Skopje from 2022 to 2024. Preoperative PSA level, mp MRI PI-RADS score, and biopsy Gleason score were recorded for each patient. The prostatectomy specimens were evaluated for the presence of peri neural invasion, lympho vascular invasion, and surgical margin status. Postoperative PSA was measured at the first follow-up; a value >0.2 NG/mL was considered a biochemical recurrence. ROC curve analysis was performed for each parameter against each outcome, calculating the area under the curve (AUC) and determining sensitivity and specificity at optimal cutoff values. RESULTS Higher PSA levels and a higher biopsy Gleason score were significantly associated with all assessed outcomes. PSA and Gleason demonstrated the greatest prognostic power, with high AUC values (often >0.80), especially for predicting positive margins and elevated postoperative PSA. For example, PSA >10 NG/mL identified positive margins with ~90% sensitivity and ~70% specificity. The PI-RADS score also correlated with pathological outcomes, but with moderate accuracy (lower AUC values). The combined evaluation of all three parameters improved predictive precision and enabled better risk stratification. CONCLUSION An integrated approach incorporating PSA, mp MRI (PI-RADS), and the biopsy Gleason score allows better prediction of adverse pathological features and the likelihood of biochemical recurrence in prostate cancer. This combined approach provides improved risk stratification and may contribute to optimal treatment decisions. KEYWORDS: prostate cancer; PSA; mp MRI; PI-RADS; positive surgical margins; biochemical recurrence; prognostic factors; ROC analysis