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Background <p>This study aimed to investigate whether systemic inflammation indices provide additional predictive value beyond conventional clinical parameters, particularly prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD), for the detection of clinically significant prostate cancer (csPCa) prior to transrectal ultrasound (TRUS)-guided prostate biopsy.</p> Methods <p>This retrospective, single-center study included patients who underwent TRUS-guided prostate biopsy due to elevated PSA levels and/or suspicious digital rectal examination findings. Data from 527 patients who underwent prostate biopsy were analyzed. Demographic data, serum PSA levels, prostate volume, PSAD, and prebiopsy complete blood count parameters were recorded. Systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and pan-immune inflammation value (PIV) were calculated. Patients were classified into three groups: benign prostate pathology, clinically insignificant prostate cancer (ciPCa), and csPCa, based on histopathological findings. Receiver operating characteristic (ROC) curve analyses and multinomial logistic regression models adjusted for age and PSAD were performed to assess predictive performance.</p> Results <p>Significant differences were observed among the benign, ciPCa and csPCa groups in terms of age, total PSA, prostate volume, and PSAD (all <i>p</i> &lt; 0.001), with csPCa patients being older and exhibiting higher PSA and PSAD values. Among the inflammatory indices, only MLR differed significantly, being higher in the csPCa group compared to the ciPCa group (<i>p</i> = 0.028). ROC analysis identified MLR as a weak but statistically significant predictor of csPCa (AUC = 0.566, <i>p</i> = 0.011). In age- and PSAD adjusted regression analyses, PLR and SII were inversely associated with ciPCa, while age and PSAD ≥ 0.15 remained independent predictors of csPCa. Additionally, each 100-unit increase in PIV significantly reduced the likelihood of ciPCa (OR = 0.886, <i>p</i> = 0.026).</p> Conclusion <p>Systemic inflammatory indices do not provide sufficient predictive power to replace established clinical parameters in pre-biopsy decision-making. PSA, PSAD and age remain the most reliable predictors of csPCa, while selected inflammatory markers may offer limited complementary information for risk stratification.</p>

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Additional predictive value of systemic inflammation indices beyond prostate specific antigen density for clinically significant prostate cancer

  • 期刊论文

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  • 发表日期：

    2026年4月18日

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  • Hasan Sulhan,
  • Bedreddin Kalyenci

摘要

Background

This study aimed to investigate whether systemic inflammation indices provide additional predictive value beyond conventional clinical parameters, particularly prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD), for the detection of clinically significant prostate cancer (csPCa) prior to transrectal ultrasound (TRUS)-guided prostate biopsy.

Methods

This retrospective, single-center study included patients who underwent TRUS-guided prostate biopsy due to elevated PSA levels and/or suspicious digital rectal examination findings. Data from 527 patients who underwent prostate biopsy were analyzed. Demographic data, serum PSA levels, prostate volume, PSAD, and prebiopsy complete blood count parameters were recorded. Systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and pan-immune inflammation value (PIV) were calculated. Patients were classified into three groups: benign prostate pathology, clinically insignificant prostate cancer (ciPCa), and csPCa, based on histopathological findings. Receiver operating characteristic (ROC) curve analyses and multinomial logistic regression models adjusted for age and PSAD were performed to assess predictive performance.

Results

Significant differences were observed among the benign, ciPCa and csPCa groups in terms of age, total PSA, prostate volume, and PSAD (all p < 0.001), with csPCa patients being older and exhibiting higher PSA and PSAD values. Among the inflammatory indices, only MLR differed significantly, being higher in the csPCa group compared to the ciPCa group (p = 0.028). ROC analysis identified MLR as a weak but statistically significant predictor of csPCa (AUC = 0.566, p = 0.011). In age- and PSAD adjusted regression analyses, PLR and SII were inversely associated with ciPCa, while age and PSAD ≥ 0.15 remained independent predictors of csPCa. Additionally, each 100-unit increase in PIV significantly reduced the likelihood of ciPCa (OR = 0.886, p = 0.026).

Conclusion

Systemic inflammatory indices do not provide sufficient predictive power to replace established clinical parameters in pre-biopsy decision-making. PSA, PSAD and age remain the most reliable predictors of csPCa, while selected inflammatory markers may offer limited complementary information for risk stratification.