The roles of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen concentrations in predicting prostate cancer and high-risk prostate cancer

PLoS One. 2019 Nov 19;14(11):e0218645. doi: 10.1371/journal.pone.0218645. eCollection 2019.


Prostate biopsies are frequently performed to screen for prostate cancer (PCa) with complications such as infections and bleeding. To reduce unnecessary biopsies, here we designed an improved predictive model of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen (PSA) concentrations for diagnosing PCa and risk stratification. Multiparametric MRI administered to 422 consecutive patients before initial transrectal ultrasonography-guided 13-core prostate biopsies from January 2012 to March 2018 at Fujian Medical University Union Hospital. Univariate and multivariate logistic regression analyses and determination of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was performed to evaluate and integrate the predictors of PCa and high-risk prostate cancer (HR-PCa). The detection rates of PCa was 43.84% (185/422). And the detection rates of HR-PCa was 71.35% (132/185) in PCa patients. Multivariate analysis revealed that prostate volume(PV), PSA density(PSAD), transitional zone volume(TZV), PSA density of the transitional zone(PSADTZ), and MR were independent predictors of PCa and HR-PCa. PSA, peripheral zone volume(PZV) and PSA density of the peripheral zone(PSADPZ) were independent predictors of PCa but not HR-PCa. The AUC of our best predictive model including PSA + PV + PSAD + MR + TZV or PSA + PV + PSAD + MR + PZV was 0.906 for PCa. The AUC of the best predictive model of PV + PSAD + MR + TZV was 0.893 for HR-PCa. In conclusion, our results will likely improve the detection rate of prostate cancer, avoiding unnecessary prostate biopsies, and for evaluating risk stratification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / immunology
  • Adenocarcinoma / pathology
  • Aged
  • Area Under Curve
  • Biopsy
  • Cohort Studies
  • Humans
  • Kallikreins / metabolism*
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging / statistics & numerical data
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prostate / diagnostic imaging*
  • Prostate / immunology
  • Prostate / pathology
  • Prostate-Specific Antigen / metabolism*
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / immunology
  • Prostatic Neoplasms / pathology
  • Retrospective Studies
  • Risk Factors
  • Watchful Waiting


  • KLK3 protein, human
  • Kallikreins
  • Prostate-Specific Antigen

Grant support

This work was supported by Startup Fund for scientific research, Fujian Medical University (Grant number: 2016QH032), Fujian Natural Sciences Foundation (Grant number: 2017J01203) and Joint Funds for the innovation of science and Technology, Fujian province (Grant number: 2017Y9023). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.