Does PSA density correlate with indicators of clinically significant prostate carcinoma?
Does PSA density correlate with indicators of clinically significant prostate carcinoma?
Caleb Gilberg; Hanna Falińska, MD; Refky Nicola, DO
The purpose of this study was to evaluate the significance of PSA density as an indicator of tumor severity in patients with clinically significant prostate carcinoma (csPCa).
Background Prostate cancer is the second most common cancer diagnosis in men worldwide. Early detection and accurate evaluation of carcinoma severity is critical to ensuring optimal outcomes for patients. Magnetic resonance imaging (MRI) has become an increasingly important tool in the diagnosis and evaluation of prostate carcinoma severity. One method that has shown promise for evaluation of prostate carcinoma severity has been the calculation of the PSA density. Materials and Methods This single-center, retrospective study included 110 men (mean age, 64 years; age range, 50-77) with csPCa who obtained a multiparametric 3T MRI and subsequent radical prostatectomy between January 1, 2017 and January 1, 2022. The average time period between MRI and prostatectomy was 5.16 months (157 days). Clinically significant prostate carcinoma is defined as having a Gleason score greater than or equal to 7 and a PI-RADS score greater than or equal to 4. Pearson and Spearman correlations were conducted to determine how PSA and PSA density correlated with Gleason scores, ISUP grades, PI-RADS scores, seminal vesicle invasion (SVI), perineural invasion (PNI), lymph node metastasis (LNM), extraprostatic extension (EPE), and the percentage of positive cores on biopsy (PPC).
67 yr old male with a PIRADS 5, ISUP 5, Gleason 9, prostate carcinoma. PSA is 23.00 ng/mL, prostate volume is 52.45mL, and PSAD is 0.44 ng/mL2. DynaCAD visualization is pictured (Figure 1), as well as T2 axial imaging (Figure 2).
Mean PSA density was 0.19 ng/mL2 PSA density had statistically significant positive correlations with... -Gleason score (r = 0.333, p < 0.001) -ISUP grade (r = 0.314, p < 0.001) -PI-RADS score (r = 0.321, p < 0.001) -LNM (r = 0.348, p = 0.011) -PPC (r = 0.275, p = 0.005) PSA had statistically significant positive correlation with… -Gleason score (r = 0.332, p < 0.001) -ISUP grade (r = 0.298, p = 0.002) -PI-RADS score (r = 0.405, p < 0.001) -LNM (r = 0.290, p = 0.003)
Both PSA density and PSA were found to correlate with Gleason, ISUP, PI-RADS, and LNM. However, PSA density also had statistically significant correlation with PPC. Additionally, PSA density was found to have stronger correlation with LNM than PSA did. These advantages may warrant the use of PSA density in the clinical decision-making process as an indicator of csPCa alongside other traditional markers. Also, further research is needed on a multi-center scale to improve the generalizability of this study to a larger population.
