[Diagnostic value of prostate cancer in the PSA gray zone by the AI-assisted transperineal fusion biopsy combined with multiparametric MRI in prostate cancer within the PSA gray zone].

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Abstract

Objective To explore the diagnostic value of multiparameter magnetic resonance imaging (mpMRI) combined with artificial intelligence (AI)-assisted transperineal ultrasound fusion biopsy in prostate cancer patients within the PSA gray zone. Methods A retrospective analysis was conducted on 286 patients with prostate-specific antigen (PSA) levels between 4 and 10 μg/L and a PIRADS score ≥3 who underwent transperineal ultrasoundguided prostate biopsy in the Departments of Urology in the Eastern Theater General Hospital and Taikang Xianlin Drum Tower Hospital from April 2022 to December 2025. All patients underwent preoperative mpMRI examination, and MRI lesions were scored according to the PIRADS v2.1 criteria. Among them, 178 cases scored 3 points, 96 cases scored 4 points, and 12 cases scored 5 points. All the patients were divided into two groups: Group A (AIassisted, n=144), in whom MR images were imported into the fusion ultrasound system and AI was used to mark target lesions be fore performing transperineal biopsy 4-6 cores were taken from targeted areas, and 8 to 10 cores from systematic sampling, totaling 13 cores; and Group B (conventional cognitive fusion puncture, n=142). Postoperative pathology results were compared to evaluate the diagnostic value of AIassisted fusion biopsy in the PSA gray zone. ResultsAmong all 286 patients in the PSA gray zone, 72 cases of prostate cancer were detected, with a total puncture positive rate of 25.2%. Among them, there were 45 cases in group A, with a puncture positive rate of 31.2%. And 27 cases in group B, with a puncture positive rate of 19.0%. The difference was statistically significant (P<0.05). Among the patients with a PI-RADS score of 3, among the 121 cases in group A, 28 cases were positive for puncture, with a positive rate of 23.1%. Among the 124 cases in group B, 16 cases were positive for puncture, with a positive rate of 12.9%. The difference was statistically significant (P<0.05). Among the patients with a PI-RADS score of 4, among the 13 cases in group A, 9 cases were positive for puncture. Among the 10 cases in group B, 6 cases were positive for puncture. Among the patients with a PI-RADS score of 5, 8 cases were positive for puncture among the 10 cases in group A and 5 cases were positive for puncture among the 8 cases in group B. There were no statistically significant differences.Conclusion AI-assisted transperineal ultrasound-guided biopsy combined with multiparametric magnetic resonance imaging demonstrates certain advantages in detecting low- and intermediate-risk lesions in the PSA gray zone, facilitating early diagnosis and precise treatment of prostate cancer.

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