The diagnostic value of serum prostate specific antigen combined with value of apparent diffusion coefficient in diffusion weighted imaging and magnetic resonance spectroscopy in prostate cancer of prostate specific antigen gray zone

Abstract

Objective To investigate the diagnostic value of prostate specific antigen (PSA) (fPSA, fPSA/tPSA, PSAD) combined with value of apparent diffusion coefficient (ADC) in diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the diagnosis of prostate cancer (PCa) between total PSA (tPSA) 4-10 μg/L. Methods From December 2013 to 2015 February, 56 elderly male patients with serum tPSA 4-10 μg/L were enrolled. Pathological examination confirmed 26 patients with PCa and 30 patients with benign prostatic hyperplasia (BPH). The levels of tPSA and free PSA(fPSA), fPSA/tPSA, Prostate specific antigen density(PSAD), ADC value according to the DWI, choline(Cho), creatine(Cre) and citrate(Cit) in MRS were analyzed, and ADC, (Cho+ Cre)/Cit combined with PSAD and fPSA/tPSA in PCa diagnosis was analyzed by receiver operating characteristic curve (ROC). Results The level of tPSA in PCa group and BPH group had no significant difference (P > 0.05), but the levels of fPSA、fPSA/tPSA、prostate volume, PSAD, (Cho+ Cre)/Cit, ADC had significant difference: (1.04±0.14) μg/L vs. (1.22±0.34) μg/L, 0.15(0.14-0.16) vs. 0.17(0.15-0.18), (41.45±5.70) cm3 vs. (48.70±9.97) cm3, 0.17(0.15-0.18) ng/(ml·cm3) vs. 0.16(0.14-0.17) ng/(ml·cm3), 2.22 ± 0.59 vs. 1.17±0.52, 0.98 ± 0.28 vs. 1.39 ± 0.24, P < 0.01 or < 0.05. The area under the curve of (AUC) fPSA/tPSA+ PSAD+ (Cho+ Cre)/Cit、fPSA/tPSA+ PSAD+ADC、fPSA/tPSA+PSAD+ (Cho+Cre)/Cit+ADC were 0.932, 0.941 and 0.977, and the AUC of fPSA/tPSA+PSAD+(Cho+Cre)/Cit+ADC was the highest. Conclusions PSAD and fPSA/tPSA and the value of ADC in DWI and MRS can be used in diagnosis of PCa. Key words: Prostatic neoplasms; Prostate specific antigen; Diffusion magnetic resonance imaging; Apparent diffusion coefficient