Background Multiparametric magnetic resonance imaging (mpMRI) has been widely utilized in clinical practice for identifying clinically significant prostate cancer (csPCa). Although mpMRI demonstrates a pooled negative predictive value (NPV) of 90%, additional clinical parameters require evaluation to enhance this metric specifically for the Chinese population—given the rising incidence of PCa in China, as well as ethnic differences in average prostate volume (PV) and chronic prostatitis prevalence that may impact mpMRI’s diagnostic performance. Methods A retrospective analysis was conducted on 543 patients who underwent transrectal ultrasound‐guided prostate biopsy at Beijing Tsinghua Changgung Hospital between November 2014 and March 2025. After applying exclusion criteria, 412 patients were enrolled, all of whom had completed prebiopsy mpMRI within 1 month prior to biopsy. Patients were stratified into four groups based on the results of MRI examination and the pathological outcomes of biopsy: MRI (−) PCa (−), MRI (+) PCa (−), MRI (−) PCa (+), and MRI (+) PCa (+) groups. Multivariate logistic regression analyses were used to assess the odd ratios (ORs) of potential predictors for csPCa, comparing the MRI (−) PCa (+) and MRI (−) PCa (−) groups. Receiver operating characteristic curves were generated to analyze the predictive values of total PSA (tPSA), free PSA (fPSA), free‐to‐total (f/t) PSA, PV, PSA density (PSAD), and adjusted PSAD (PSAD adj , defined as PSAD × weight) for csPCa in patients with negative MRI. Results The patient distribution was as follows: MRI (−) PCa (−) group: 27.9% (115/412), MRI (+) PCa (−) group: 36.9% (152/412), MRI (−) PCa (+) group: 2.4% (10/412), and MRI (+) PCa (+) group: 32.8% (135/412). The NPV of MRI for csPCa was 92%. Multivariate analyses indicated that PV was negatively associated with the presence of csPCa (OR = 0.940, 95% CI: 0.896–0.986, p = 0.012), while PSAD and PSAD adj were positively associated with csPCa occurrence (OR = 10.288, 95% CI: 1.569–67.46, p = 0.015; OR = 1.027, 95% CI: 1.001–1.053, p = 0.043, respectively). For MRI‐negative patients, PV > 55.25 mL (sensitivity = 100%, specificity = 63.2%), PSAD 55.25 mL, PSAD < 0.100 ng/mL 2 , or PSAD adj < 7.24 ng/mL may elevate mpMRI’s NPV from 92% to 100%, enabling safe avoidance of unnecessary biopsies. Prospective multicenter validation is required to confirm these findings.
Wang et al. (Thu,) studied this question.