Transition-zone PSA density predicts clinically significant prostate cancer in PI-RADS 3 lesions and may avoid most biopsies

In 395 biopsy-naive men with PI-RADS 3 MRI lesions, transition-zone PSA density had an AUC of 0.927 for clinically significant prostate cancer vs 0.902 for whole-gland PSAD. A TZ-PSAD cutoff of at least 0.331 ng/mL2 could avoid 74.9% of biopsies while missing only 2 cancers.

• Only 22 of 395 patients (5.6%) had clinically significant prostate cancer; TZ-PSAD AUC was 0.927, PSAD 0.902, and PSA 0.737. Both density measures outperformed PSA (p<0.001), with no significant difference between the two densities (p=0.163).
• At a TZ-PSAD threshold of at least 0.331 ng/mL2, 74.9% of biopsies could be avoided and the cancer detection rate among biopsied patients rose to 35.7%; a PSAD threshold of at least 0.15 ng/mL2 avoided 65.8% with a 19.3% detection rate. Both strategies missed 2 clinically significant cancers.
• In multivariable analysis, only TZ-PSAD remained an independent predictor (OR 1.06, 95% CI 1.02-1.10, p=0.009). The study was single-center and retrospective, and the authors note that prospective multicenter validation is warranted.

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