Re-assesment of prostate spesific antigen and delivers (PSA, FREE-PSA) by transrectal ultrasonography acrossed prostate biopsy (TRUS-BX) results by multiparametric prostate magneti̇c resonance imaging

It was aimed to evaluate the relationships between freePSA/PSA ratios, multiparametric magnetic resonance imaging and pathology reports in patients with prostate specific antigen (PSA) value of 4-10ng/dl, called the gray zone. Between 2020-2022, 101 patients with high prostate specific antigen value and gray zone (4-10 ng/dl), who underwent multiparametric magnetic resonance imaging and then underwent prostate biopsy under transrectal ultrasonography were included in our study. The patients were divided into two groups as those with benign and malignant pathology. The fPSA/PSA ratios, PIRADS scores of the patients in both groups, as well as the pathology results of the patients in the malignant group were recorded according to the Gleason score. We tried to reveal the value of FreePSA/PSA ratio, PIRADS scores and the relationship between them in detecting prostate cancer. The mean age of 101 patients in the study was 64.34 ± 6.64, PSA value was 7.63 ± 2.3 ng/dl, fPSA value was 1.42 ± 0.77 ng/dl, fPSA/PSA ratio was 0.19 ± 0.09. According to the pathology results of 101 patients, 31 of them were diagnosed with cancer (31.7%), 3 of them were reported as ASAP (3%), and the results of 67 of them were benign (66.3%). The mean fPSA of the patients in group 1 was 1.08 ± 0.71 ng/dl, and the mean fPSA of the patients in group 2 was 1.59 ± 0.74 ng/dl (p=0.001). The mean fPSA/PSA ratio of the patients in group 1 was 0.13 ± 0.06, and the mean fPSA/PSA ratio of the patients in group 2 was 0.22 ± 0.08 (p=0.001). Pathology results according to Gleason scores of 31 patients diagnosed with prostate cancer, 12 patients Gleason 3+3, 8 patients Gleason 3+4, 3 patients Gleason 4+3, 3 patients Gleason 4+4, 2 patients Gleason 4+5, 2 patients Gleason 5 +3, 2 patients were reported as Gleason 5+5. According to the multiparametric magnetic resonance imaging reports of 101 patients, 1 patient was PIRADS-2 (1%), 33 patients were PIRADS-3 (32.7%), 55 patients were PIRADS-4 (54.5%), and 12 patients were PIRADS-5 (11.9%). Prostate cancer was diagnosed in 3 of 33 patients with a PIRADS-3 score, 22 out of 55 patients with a PIRADS-4 score, and 6 out of 12 patients with a PIRADS 5 score. The cut-off value for the mean fPSA/PSA ratio in patients diagnosed with prostate cancer was found to be ≤0.15, and according to this cut-off value, the sensitivity of the mean fPSA/PSA value is 76% and the specificity is 85% (p<0.001). According to MpMRI reports, 3 of the patients with PIRADS-3 and prostate ca were also gleason 3+3 (100%), 6 patients with PIRADS 4 and prostate ca were gleason 3+3 (27%), 8 patients were 3+ 4 (36%) , 1 patient 4+3(4%), 3 patients 4+4(13%), 1 patient 4+5(4%), 2 patients 5+3(9%), 1 patient 5+ 5(4%) pathology results. 3 patients with PIRADS 5 and prostate ca had gleason 3+3(50%), 2 patients had 4+3(33%), 1 patient had 4+5(17%) pathology results. The importance of calculating the fPSA/PSA ratio and making a biopsy decision in patients with a PSA value of 4-10 ng/dl is understood. MpMRI and PIRADSv2 scoring methods, which are thought to be groundbreaking in the diagnosis of prostate cancer in recent years, have been found to be significantly helpful in diagnosing cancer. In our study, it was determined that the rate of being diagnosed with cancer increased with the high PIRADS score, and the rate of free/total PSA decreased, which revealed the importance of PSA derivatives in making the diagnosis.