Zone-Specific PSA Density from AI-Assisted mp-MRI as a Predictor of Prostate Cancer in the PSA 4-20 ng/mL Range.

Authors

Abdullah Golbasi, Huseyin Bicer, Ali Yasin Ozercan, Burak Elmaagac, Omer Sahin, Mert Ali Karadag

Published in

Journal of clinical medicine. Volume 15. Issue 15. Jul 23, 2026. Epub Jul 23, 2026.

Abstract

Background/Objectives: Serum prostate-specific antigen (PSA) lacks sufficient specificity for prostate cancer (PCa) detection. We evaluated the diagnostic value of AI-assisted MRI-derived zone-specific PSA density parameters, including transition zone PSA density (TZ-PSAD) and peripheral zone PSA density (PZ-PSAD), in men undergoing prostate biopsy. Methods: This retrospective cohort study included 354 patients who underwent prostate biopsy due to elevated PSA (2024-2026), stratified into PSA 4-10 ng/mL (n = 272) and PSA 10-20 ng/mL (n = 82) groups. Zonal volumes were measured using AI-assisted mp-MRI segmentation per PI-RADS v2.1, and PSAD, TZ-PSAD, and PZ-PSAD were calculated accordingly. MRI readings were performed blinded to pathology. Results: TZ-PSAD was significantly higher in PCa patients in both PSA groups (p < 0.001), demonstrating superior AUC compared to PSAD in both the PSA 4-10 ng/mL (0.711 vs. 0.660) and PSA 10-20 ng/mL (0.841 vs. 0.676) groups. At an optimal cut-off of ≥0.34 ng/mL², TZ-PSAD yielded 44.8% sensitivity and 90.8% specificity in the PSA 4-10 group, improving to 73.8% sensitivity and 94.7% specificity at ≥0.48 ng/mL² in the PSA 10-20 group. On multivariate analysis, TZ-PSAD and PI-RADS ≥ 3 emerged as independent predictors of PCa in both groups. Serum PSA, PZ-PSAD, and PZ volume failed to differentiate BPH from PCa in either group. Conclusions: TZ-PSAD and conventional PSAD were both significantly associated with prostate cancer, whereas PZ-PSAD was not, and TZ-PSAD, combined with PI-RAD ≥3, emerged as an independent predictor in the PSA gray zone.

PMID:
42589872
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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