GIÁ TRỊ CỦA THANG ĐIỂM PIRADS V2.1 TRÊN CỘNG HƯỞNG TỪ KẾT HỢP PSA TỶ TRỌNG TRONG CHẨN ĐOÁN UNG THƯ TUYẾN TIỀN LIỆT

Abstract

Objective: To evaluate the effectiveness of diagnosing malignant prostate lesions using a combination of the PIRADS v2.1 scoring system on MRI and PSA density (PSAD), in order to avoid unnecessary prostate biopsies. Materials and Methods: This retrospective and prospective study included 139 patients who underwent MRI and prostate biopsy from February 2021 to May 2024 at Hanoi Medical University Hospital. The study assessed the diagnostic value of the PIRADS v2.1 score, PSA levels, PSA density, and the ratio of free-to-total PSA in relation to the histopathological results post-biopsy. Results: The average PSAD of the study group was 0.53 ng/ml²; in the cancer group, it was 0.86 ± 0.88 ng/ml², while in the non-cancer group, it was 0.40 ± 0.39 ng/ml². Among patients with PIRADS 3, only 12.2% were diagnosed with cancer, whereas this figure was 85% for PIRADS 5. No cancer patients had a PIRADS classification below 3. The area under the curve (AUC) for the PIRADS score and PSAD was 0.89 and 0.701, respectively. At a threshold of PIRADS ≥ 4, PIRADS v2.1 demonstrated a sensitivity of 87.8% and specificity of 72.4%. At a PSAD threshold of ≥ 0.5 ng/ml², PSAD exhibited a sensitivity of 63.4% and specificity of 78.6%. The combination of PIRADS v2.1 and PSAD for diagnosing prostate cancer showed a sensitivity of 92.6% and specificity of 93.9%, with a positive predictive value of 86.4% and a negative predictive value of 96.8%. Conclusion: The combination of PSA density and PIRADS v2.1 improves the diagnostic accuracy for prostate cancer. Patients with a PIRADS score ≤3 and PSA density <0.15 ng/ml² may avoid unnecessary prostate biopsies.