In astronomy, news of a relatively rare alignment of heavenly bodies tends to generate excitement on planet earth. For example, over an 18-year period, only three or four total lunar eclipses will be visible from beginning to end (depending where you are and assuming the night is clear).

I got excited over the convergence of two journal articles that appeared within a couple of weeks of each other in November, 2022. Both articles discussed the PSA density (PSAD) test as a value-added when included in an MRI diagnostic scan for prostate cancer (PCa).

The first article by Díaz-Fernández, et al. was submitted by a team of authors from a university medical center in Barcelona, Spain. Their paper reported on a review of published literature on methods for improving the performance of MRI (“the test of choice for the diagnosis of prostate cancer”) and targeted biopsies.^[i] Out of 297 possible published articles, they ultimately chose 21 to synthesize and analyze the data. They found that, compared with other biomarkers or clinical factors, the inexpensive PSAD test was the most powerful value-added tool for predicting findings of clinically significant PCa (csPCa) upon biopsy.

Thus, their survey was valuable because they discovered a preponderance of evidence pointing to PSAD for boosting the diagnostic value of prostate MRI.

Even better…

The second article by Chinese researchers was even more thrilling because it produced a conclusion that affirms the Díaz-Fernández paper. In the article by Wang, et al. the authors describe their retrospective evaluation of 833 patient cases from January 2018 to April 22.^[ii] Their goal was to explore a way to reduce unnecessary biopsies. In order to achieve their goal, they analyzed which combination of prostate MRI and biomarker could produce the greatest predictive accuracy for total PCa and csPCa.

They found that when results of a PSAD test were integrated with a patient’s PI-RADS score from his MRI scan, the accuracy was “extraordinary”, as they put it. Depending on how they combined specific criteria (PI-RADS score >3, PI-RADS score ≥3, PSAD ≥0.3, their results ranged from 92.6% to 96.8% accuracy for total PCa, and 82.4% to 99.3% accuracy for csPCA.

Their conclusion is encouraging news for PCa patients: “Many patients may safely execute active surveillance or take systematic treatment without prostate biopsies by stratification according to the PI RADS score and the value of PSAD.” It almost seems too good to be true because it’s so simple to add a blood test result to a PI-RADS cutoff of 3 or greater. Taken together, these two studies are like astronomical bodies orbiting each other. Is it a coincidence that the papers were published two weeks apart? I doubt it, because the trend to use MRI to determine who does or does not need a biopsy is cresting. It doesn’t take a powerful telescope to see that these articles add two bright lights to the cosmos of prostate cancer detection and diagnosis.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Díaz-Fernández F, Celma A, Salazar A, Moreno O et al. Systematic review of methods used to improve the efficacy of magnetic resonance in early detection of clinically significant prostate cancer. Actas Urol Esp (Engl Ed). 2022 Nov 30:S2173-5786(22)00138-X.
[ii] Wang C, Yuan L, Shen D, Zhang B et al. Combination of PI-RADS score and PSAD can improve the diagnostic accuracy of prostate cancer and reduce unnecessary prostate biopsies. Front Oncol. 2022 Nov 16;12:1024204.