Bostanci, C.Demir, D. O.2024-09-292024-09-2920240210-48061699-7980https://doi.org/10.1016/j.acuro.2023.08.001https://hdl.handle.net/20.500.14619/4348Objective: 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: One hundred ninety-one 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 risk groups according to these two parameters: center dot PSAD 0.01-0.07 ng/ml/ml and f/t PSA ratio >= 25 in a low -risk group. center dot PSAD 0.08-0.15 ng/ml/ml, and f/t PSA ratio 0.15-0.24 in an intermediate -risk group and high -risk group. center dot PSAD>0.15 ng/ml/ml and f/t PSA ratio <15 in high -risk group, 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 and f/t PSA>15. Conclusion: f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/ml/ml and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study. (c) 2023 AEU. Published by Elsevier Espa & ntilde;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.acuro.2023.08.001245323848WOS:001223638000001N/A