Early Differentiation of Prostatic Intraepithelial Neoplasia via Multiparametric MRI Combined with PSA-derived Parameters.

BACKGROUND

Prostatic intraepithelial neoplasia (PIN) is a precancerous lesion. Early differentiation of PIN is very important for the prevention of PIN occurrence and malignization.

OBJECTIVES

To differentiate prostatic intraepithelial neoplasia (PIN) via multiparametric MRI (mpMRI) combined with prostate-specific antigen (PSA)-derived parameters.

MATERIALS AND

METHODS

From March 2022 to June 2024, 47 males, including 39 with benign prostatic hyperplasia (BPH) and 8 with PIN, were enrolled. All patients underwent prostatic mpMRI. The apparent diffusion coefficients (ADC), Ktrans, kep, ve, initial area under curve (iAUC), and PI-RADS score were derived from mpMRI. The parameters between PIN and BPH were compared via Student's t test or Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy.

RESULTS

The ADC value of PIN was significantly greater than that of BPH (0.912 vs. 0.806 × 10-3 mm2/s, P=0.035). The tPSA, fPSA, and PSA density (PSAD) of PIN were significantly lower than those of BPH (6.715 vs. 11.640 ng/mL, P=0.008; 1.427 vs. 2.109 ng/mL, P=0.042; 0.095 vs. 0.158 ng/mL2, P=0.010; respectively). The AUC of tPSA was slightly greater than those of PSAD, ADC, and fPSA (0.801 > 0.792 > 0.724 > 0.716) in differentiating PIN from BPH. When the tPSA was ≤ 8.47 ng/mL, the highest sensitivity (87.5%) and negative predictive value (96.8%) were observed in differentiating PIN from BPH. When the ADC and PSA-derived parameters were combined, the highest specificity (94.9%) was acquired in differentiating PIN from BPH. ADC (OR=0.120, P = 0.043) and PSAD (OR=0.056, P = 0.005) were independent risk predictors for differentiating PIN from BPH.

DISCUSSION: ADC derived from mpMRI combined with PSA-derived parameters exhibit enormous potential for differentiating PIN from BPH.

CONCLUSIONS

ADC and PSA-derived parameters can distinguish PIN from BPH. The ADC value combined with tPSA can achieve the highest diagnostic efficiency in detecting PIN. The ADC may function as a potential biomarker to differentiate precancerous lesions of the prostate.