| Aims: The aim of this study was to compare PI-RADS (Prostate Imaging-Reporting and Data System) categories, prostate volume, and prostate-specific antigen (PSA) parameters among prostate biopsy results. Methods: A total of 367 patients who underwent multiparametric magnetic resonance imaging (mpMRI) between July 2021 and February 2023 were retrospectively analyzed. Age, total PSA (tPSA), free PSA (fPSA), tPSA/fPSA ratio, PSA density (PSAD, tPSA/prostate volume), and PI-RADS categories were recorded for each patient. 199 patients were excluded from the study due to insufficient data, and the study was conducted with the remaining 168 patients. The mpMRI were performed using a 1.5 T MRI scanner. PI-RADS categories 1, 2, and 3 obtained from mpMRI were classified as PI-RADS≤3, while PI-RADS categories 4 and 5 were classified as PI-RADS>3. Prostate biopsy was performed as a 12-core biopsy under transrectal ultrasonography (TRUS) guidance. Independent samples T test, Mann-Whitney U test and Chi-square test were used to compare the data of histopathologically benign and malignant groups. A p-value <0.05 was considered statistically significant. Results: Of the 168 patients included in the study, 105 (62.5%) were benign and 63 (37.5%) were malignant based on histopathological results. Statistically significant differences were found between malignant/benign groups in mean age (69.9/67.0 years, p=0.002), prostate volume (62.5/93.9 ml, p<0.001), fPSA/tPSA ratio (0.13/0.20, p=0.048), and PSAD (0.25/0.14 ng/ml2, p=0.003); while no significant differences were found in tPSA (13.9/11.5 ng/ml, p=0.419) and fPSA (1.63/1.68 ng/ml, p=0.922) values. A statistically significant difference was found between PI-RADS results of malignant/benign cases (p<0.001). Of the cases classified as PI-RADS>3 according to PI-RADS, 44 (26.2%) cases were histopathologically benign, while 21 (12.5%) cases classified as PI-RADS≤3 according to PI-RADS were histopathologically malignant. In the remaining 103 (61.3%) cases, PI-RADS and histopathology results were concordant. Conclusion: Our study demonstrated that while tPSA and fPSA alone were insufficient for detecting prostate malignancy, fPSA/ tPSA ratio and PSAD showed significant association with histopathologically confirmed malignancy. An inverse relationship was observed between prostate volume and malignancy risk. Substantial discordance (38.7%) was detected between PI-RADS categories and histopathological results, which may be attributed to the limitations of TRUS-guided 12-core prostate biopsy. Evidence suggests that MRI/TRUS fusion biopsy could improve concordance between imaging findings and histopathological results. In clinical practice, the combined evaluation of PSA parameters, prostate volume measurements, and mpMRI data offers more accurate prediction of prostate cancer compared to individual parameters alone. |
Mustafa Koyun
Dr. Öğr. Üyesi İsmail TAŞKENT
Doç. Dr. Bünyamin ECE
Özgün Makale
