MUSTAFA KOYUN, İSMAİL TAŞKENT, BÜNYAMİN ECE
Kastamonu Medical Journal - 2025;5(3):182-187
Aims: The aim of this study was to compare prostate biopsy results with PI-RADS (Prostate Imaging-Reporting and Data System) categories, prostate volume, and prostate-specific antigen (PSA) parameters. METHODS: A total of 367 patients who underwent mpMRI between July 2021 and February 2023 were retrospectively analyzed. Age, total PSA (tPSA), free PSA (fPSA), tPSA/fPSA ratio, PSA density (PSAD, tPSA/prostate volume), and PI-RADS (Prostate Imaging-Reporting and Data System) categories were recorded for each patient. 199 patients were excluded from the study due to insufficient data, and the study was conducted with the remaining 168 patients. The mpMRI examinations were performed using a 1.5 T MRI scanner. PI-RADS categories 1, 2, and 3 obtained from mpMRI were classified as benign, while PI-RADS categories 4 and 5 were classified as malignant. Prostate biopsy was performed as a 12-core biopsy under transrectal ultrasonography (TRUS) guidance. Independent samples t-test and Chi-square test were used to compare the data of histopathologically benign and malignant groups. A p-value <0.05 was considered statistically significant. Results: Of the 168 patients included in the study, 105 (62.5%) were benign and 63 (37.5%) were malignant based on histopathological results. Statistically significant differences were found between malignant/benign groups in mean age (69.9/67.0 years, p=0.002), prostate volume (62.5/93.9 mL, p<0.001), fPSA/tPSA ratio (0.13/0.20, p=0.048), and PSAD (0.25/0.14 ng/mL2, p=0.003); while no significant differences were found in tPSA (13.9/11.5 ng/mL, p=0.419) and fPSA (1.63/1.68 ng/mL, p=0.922) values. A statistically significant difference was found between PI-RADS results of malignant/benign cases (p<0.001). Of the cases classified as malignant according to PI-RADS, 44 (26.2%) cases (18 prostatitis, 26 benign prostate tissue) were histopathologically benign, while 21 (12.5%) cases (8 high-grade prostatic intraepithelial neoplasia, 13 malignant cases) classified as benign according to PI-RADS were histopathologically malignant. In the remaining 103 (61.3%) cases, PI-RADS and histopathology results were concordant. Conclusion: According to our study, while tPSA and fPSA alone were insufficient in detecting prostate malignancy, fPSA/tPSA ratio and PSAD were found to be associated with malignancy. Discordance was detected between PI-RADS categories and histopathological results. The discrepancy between mpMRI and histopathological data may be attributed to the systematic 12-core blind biopsy procedure. MRI-guided biopsy might reduce the discordance between PI-RADS categories and histopathological results. In conclusion, the combined use of PSA parameters and mpMRI data will provide more accurate results in predicting prostate cancer.
