PI-RADS v2.1 plus PSA density outperforms either marker alone for transition-zone prostate cancer

Combining PI-RADS v2.1 with PSA density (PSAD) raised AUC to 0.873 (95% CI 0.835–0.905) vs 0.802 for PI-RADS alone and 0.808 for PSAD alone in distinguishing transition-zone prostate cancer from BPH — retrospective, single-center, n=377.

• Retrospective study; 139 TZ prostate cancer vs 238 BPH patients; two radiologists independently scored prostate MRI using PI-RADS v2.1; ROC analysis used for diagnostic performance.
• Combined model specificity reached 86.55% vs 74.37% for PI-RADS alone and 77.31% for PSAD alone (PSAD cutoff 0.22 ng/mL/mL; PI-RADS cutoff ≥4); sensitivity was similar across all three (~79%).
• Key limitation: retrospective, single-center design with no external validation cohort; generalizability to broader practice settings is uncertain.

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