Predictive value of the combined use of PHID and ADC parameters for prostate biopsy decision-making in PI-RADS 3 lesions
5 affiliations
- 1Department of Urology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi, Jiangsu Province 214187 People’s Republic of China
- 2Wuxi Huishan District People’s Hospital, Wuxi, Jiangsu Province 214187 People’s Republic of China
- 3Department of Gastroenterology, General Hospital of Tisco (The Sixth Hospital of Shanxi Medical University), Taiyuan, Shanxi Province 030000 People’s Republic of China
- 4Department of Urology, Shandong Public Health Clinical Center, Jinan, Shandong Province 250132 People’s Republic of China
- 5Department of Imaging, Baotou city central hospital, Baotou, Inner Mongolia 014040 People’s Republic of China
Abstract
Objective: To evaluate the diagnostic accuracy of combining the Prostate Health Index density (PHID) with apparent diffusion coefficient (ADC) parameters in patients with multiparametric magnetic resonance imaging (mp-MRI) showing Prostate Imaging Reporting and Data System Version 2.1 (PI-RADS v2.1) score 3 lesions.
Patients and method: A retrospective analysis was conducted in 207 patients with PI-RADS 3 lesions who underwent mp-MRI and had tPSA, fPSA, and p2PSA measured prior to prostate biopsy at a single center from January 2019 to December 2024. ADC values were assessed on a single slice of mp-MRI using region-of-interest (ROI) analysis. Logistic regression analyses and receiver operating characteristic (ROC) curves were used to evaluate predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). DeLong tests were performed to compare AUCs, and multivariable logistic regression was used to assess independent predictors.
Result: Of the 207 men included, 69 (33.3%) were diagnosed with PCa and 37 (17.9%) with csPCa. Suspicious PI-RADS 3 lesions in the peripheral zone exhibited significantly lower ADC-lesion and ADC-average values in both the PCa and csPCa groups (p < 0.001 and p = 0.027, respectively). ROC analysis showed that PHID and ADC parameters were significant predictors of PCa and csPCa (p < 0.001). When combining PHID with ADC parameters using optimal cut-off values, the best performance was achieved by PHID & ADC-peri-lesion, with an AUC of 0.846 for PCa and 0.879 for csPCa. DeLong tests confirmed that the combined PHID-ADC approach had significantly higher AUC than PHID alone (p = 0.004) and ADC-peri-lesion alone (p = 0.027) for csPCa prediction. Multivariable analysis confirmed PHID (OR = 1.048, p < 0.001) and ADC-peri-lesion (OR = 3.214, p < 0.001) as independent predictors of csPCa.
Conclusion: The combined use of PHID and ADC parameters improves PCa and csPCa detection in patients with PI-RADS 3 lesions. ADC parameters in suspicious PI-RADS 3 lesions of the peripheral zone demonstrate superior diagnostic value. PHID and ADC parameters are independent predictors of csPCa even after multivariable adjustment.
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BibTeX
@article{cao2026predictive,
title = {{Predictive value of the combined use of PHID and ADC parameters for prostate biopsy decision-making in PI-RADS 3 lesions}},
author = {Hongfa Cao and Yan Guo and Xu Zhao and Yupeng Zuo and Zhengyu Xing and Qiang Zhang},
journal = {BMC Urology},
year = {2026},
month = jul,
doi = {10.1186/s12894-026-02290-3},
url = {https://doi.org/10.1186/s12894-026-02290-3},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Predictive value of the combined use of PHID and ADC parameters for prostate biopsy decision-making in PI-RADS 3 lesions
AU - Hongfa Cao
AU - Yan Guo
AU - Xu Zhao
AU - Yupeng Zuo
AU - Zhengyu Xing
AU - Qiang Zhang
PY - 2026
DA - 2026/07/01
JO - BMC Urology
DO - 10.1186/s12894-026-02290-3
UR - https://doi.org/10.1186/s12894-026-02290-3
AB - Objective: To evaluate the diagnostic accuracy of combining the Prostate Health Index density (PHID) with apparent diffusion coefficient (ADC) parameters in patients with multiparametric magnetic resonance imaging (mp-MRI) showing Prostate Imaging Reporting and Data System Version 2.1 (PI-RADS v2.1) score 3 lesions. Patients and method: A retrospective analysis was conducted in 207 patients with PI-RADS 3 lesions who underwent mp-MRI and had tPSA, fPSA, and p2PSA measured prior to prostate biopsy at a single center from January 2019 to December 2024. ADC values were assessed on a single slice of mp-MRI using region-of-interest (ROI) analysis. Logistic regression analyses and receiver operating characteristic (ROC) curves were used to evaluate predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). DeLong tests were performed to compare AUCs, and multivariable logistic regression was used to assess independent predictors. Result: Of the 207 men included, 69 (33.3%) were diagnosed with PCa and 37 (17.9%) with csPCa. Suspicious PI-RADS 3 lesions in the peripheral zone exhibited significantly lower ADC-lesion and ADC-average values in both the PCa and csPCa groups (p < 0.001 and p = 0.027, respectively). ROC analysis showed that PHID and ADC parameters were significant predictors of PCa and csPCa (p < 0.001). When combining PHID with ADC parameters using optimal cut-off values, the best performance was achieved by PHID & ADC-peri-lesion, with an AUC of 0.846 for PCa and 0.879 for csPCa. DeLong tests confirmed that the combined PHID-ADC approach had significantly higher AUC than PHID alone (p = 0.004) and ADC-peri-lesion alone (p = 0.027) for csPCa prediction. Multivariable analysis confirmed PHID (OR = 1.048, p < 0.001) and ADC-peri-lesion (OR = 3.214, p < 0.001) as independent predictors of csPCa. Conclusion: The combined use of PHID and ADC parameters improves PCa and csPCa detection in patients with PI-RADS 3 lesions. ADC parameters in suspicious PI-RADS 3 lesions of the peripheral zone demonstrate superior diagnostic value. PHID and ADC parameters are independent predictors of csPCa even after multivariable adjustment.
SN - 1471-2490
ER -