Diagnostic Efficiency of Age-Adjusted PSAD for Prostate Cancer and Clinically Significant Prostate Cancer: Construction and Nomogram Validation.

BACKGROUND

Prostate-Specific Antigen (PSA) is widely used for Prostate Cancer (PCa) screening, but its low specificity often leads to false-positive results and unnecessary biopsies. To address this issue, we introduced Age-Adjusted Prostate-Specific Antigen Density (A-PSAD) as a potential biomarker to improve screening accuracy for PCa and Clinically Significant Prostate Cancer (csPCa).

METHODS

In this study, 663 patients who underwent prostate biopsy between 2020 and 2024 were included. The diagnostic performance of A-PSAD, PSAD, and other biomarkers was compared. Key variables, including age, diabetes history, FPSA, prostate volume, and A-PSAD, were selected using Lasso regression to develop a nomogram prediction model (Nomo1). Additionally, the PI-RADS score was incorporated into a second model (Nomo2).

RESULTS

A-PSAD outperformed PSAD in PCa and csPCa screening. For PCa, A-PSAD had a higher AUC (0.753 vs. 0.732) with 71.86% sensitivity and 70.69% specificity, compared to PSAD's 74.87% and 63.15%. For csPCa, A-PSAD's AUC was 0.731 versus 0.708, with sensitivities of 76.27% and 57.61%. The nomogram model, based on Lasso-selected variables, achieved AUCs of 0.796 and 0.812 in the training and validation sets, with C-indices of 0.7870 and 0.7935, indicating good predictive performance. Decision curve analysis showed high clinical benefit across most risk thresholds. Incorporating PI-RADS, the Nomo2 model improved diagnostic performance in high-risk patients (AUC 0.8202) without significant difference from Nomo1 (AUC 0.8198, p > 0.05).

CONCLUSION

A-PSAD offers a better balance between sensitivity and specificity compared to PSAD, reducing false positives and unnecessary biopsies, and presents a promising tool for personalized PCa screening.