Evaluation of transabdominal and transperineal ultrasound-derived prostate specific antigen (PSA) density and clinical utility compared to MRI prostate volumes: A feasibility study

Maria Pantelidou, Iztok Caglic, Anne George, Oleg Blyuss, Vincent J. Gnanapragasam, Tristan Barrett, Pascal A. T. Baltzer (Editor)

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Abstract

Purpose: To investigate the accuracy of surface-based ultrasound-derived PSA-density (US-PSAD) versus gold-standard MRI-PSAD as a risk-stratification tool. 

Methods: Single-centre prospective study of patients undergoing MRI for suspected prostate cancer (PCa). Four combinations of US-volumes were calculated using transperineal (TP) and transabdominal (TA) views, with triplanar measurements to calculate volume and US-PSAD. Intra-class correlation coefficient (ICC) was used to compare US and MRI volumes. Categorical comparison of MRI-PSAD and US-PSAD was performed at PSAD cut-offs 0.20 ng/mL2 to assess agreement with MRI-PSAD risk-stratification decisions. 

Results: 64 men were investigated, mean age 69 years and PSA 7.0 ng/mL. 36/64 had biopsy-confirmed prostate cancer (18 Gleason 3+3, 18 Gleason ≥3+4). Mean MRI-derived gland volume was 60 mL, compared to 56 mL for TA-US, and 65 mL TP-US. ICC demonstrated good agreement for all US volumes with MRI, with highest agreement for transabdominal US, followed by combined TA/TP volumes. Risk-stratification decisions to biopsy showed concordant agreement between triplanar MRI-PSAD and ultrasound-PSAD in 86–91% and 92–95% at PSAD thresholds of >0.15 ng/mL2 and >0.12 ng/mL2, respectively. Decision to biopsy at threshold >0.12 ng/mL2, demonstrated sensitivity ranges of 81–100%, specificity 85–100%, PPV 86–100% and NPV 83–100%. Transabdominal US provided optimal sensitivity of 100% for this clinical decision, with specificity 85%, and transperineal US provided optimal specificity of 100%, with sensitivity 87%. 
Conclusion: Transperineal-US and combined TA-TP US-derived PSA density values compare well with standard MRI-derived values and could be used to provide accurate PSAD at presentation and inform the need for further investigations.
Original languageEnglish
Article numbere0274014
Number of pages13
JournalPLoS ONE
Volume17
Issue number9
Early online date9 Sept 2022
DOIs
Publication statusE-pub ahead of print - 9 Sept 2022

Keywords

  • Research Article
  • Medicine and health sciences
  • Research and analysis methods
  • Biology and life sciences

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