Integrated assessment of age, PSA and PI-RADS score in correlation with histopathological outcome in prostate cancer

Abstract

re-biopsy evaluation of prostate cancer relies on the integration of clinical, biological, and imaging parameters; however, the relative contribution of age, total PSA, and the PI-RADS score in correlation with histopathological outcomes requires further clarification. This retrospective study included 218 patients evaluated by multiparametric prostate magnetic resonance imaging and prostate biopsy, for whom complete data on age, total PSA, PI-RADS score, and histopathological results were available. Clinically significant prostate cancer was defined as adenocarcinoma with a Gleason score ≥7. Statistical analysis included univariate and multivariate logistic regression, as well as assessment of discriminatory performance using the area under the receiver operating characteristic curve (AUC). Prostate cancer was identified in 73.9% of patients, with clinically significant forms in 53.7%. Age, analyzed as a continuous variable, showed no significant association with either the presence of malignancy or clinically significant prostate cancer. Total PSA was associated with histopathological outcomes, while the PI-RADS score demonstrated the highest discriminatory ability for prostate cancer and for Gleason score ≥7 (p < 0.001). In multivariate analysis, the inclusion of PSA and PI-RADS improved the model’s discriminatory performance compared with univariate models (AUC = 0.75–0.76). Age was not significantly correlated with histopathological outcomes. The combined use of total PSA and PI-RADS score allows more accurate pre-biopsy oncological risk stratification and supports the use of multiparametric magnetic resonance imaging in the evaluation of patients prior to prostate biopsy.