Bostanci, C.Demir, D. O.2024-09-292024-09-2920240210-48061699-7980https://doi.org/10.1016/j.acuroe.2023.10.004https://hdl.handle.net/20.500.14619/4349Objective: To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. Methods: 191 patients with PSA levels between 4 -10 mg/mL and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/mL/mL, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three groups according to these two parameters, which were PSAD 0.01 -0.07 ng/mL/mL and PSA ratio >= 25 in a low-risk group, PSAD 0.08 -0.15 ng/mL/mL, and f/t PSA ratio 0.15 -0.24 an intermediate-risk group and high -risk group, in which PSAD > 0.15 ng/mL/mL and f/t ratio <15. Results: NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high -risk group. NPV of negative mpMRI results were so close when combined with PSAD < 0.15 ng/mL/mL f/t PSA > 15. Conclusion: f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. advise not to avoid prostate biopsy when PSAD is >0.15 ng/mL/mL and the f/t PSA ratio <0.15. However, we need randomized controlled studies with more patients to confirm study. (c) 2023 AEU. Published by Elsevier Espan a, S.L.U. All rights reserved.eninfo:eu-repo/semantics/closedAccessFree/total prostate-specific antigen ratioProstate specific antigen densityMultiparametric prostate magnetic resonance imaginArticle10.1016/j.acuroe.2023.10.00424533783832623848WOS:001220627500001N/A