Association of Prostate Imaging Reporting and Data System (PI-RADS) Score and Prostate-Specific Antigen Density (PSAD) With Prostate Biopsy Histology Outcomes: A Retrospective Study

The median patient age was 68.7 years, median PSA 8.20 ng/mL, and median PSAD 0.17 ng/mL². About 30.1% of biopsies were benign, with malignancies in 69.9% (34.7% Gleason 6; 65.3% Gleason ≥7). High PSAD (≥0.15 ng/mL²) and high PI-RADS (4-5) independently are strongly associated with Gleason ≥7 cancers (OR 5.63 and 95% CI 3.54-8.96; OR 9.14 and 95% CI 4.36-19.19; both p<0.001). PI-RADS 3 demonstrated non-significant trends. Age was an independent predictor of clinically significant cancer but not Gleason 1 disease (OR 1.04; 95% CI 1.01-1.07; p=0.01) Conclusions: Elevated PSAD and high PI-RADS scores are strongly associated with Gleason ≥7 cancers. PSAD also adds discriminatory value in PI-RADS 3 lesions.