Triple-positive profile may flag adverse prostate cancer pathology

A combination of PSA density, MRI, and PSMA PET findings identified a small subgroup with adverse pathology, supporting further study of biopsy-sparing pathways.

By
Andrea Surnit
September 8, 2026
4 min

MDSpire News

Objective:

To evaluate the combination of prostate-specific antigen density, multiparametric magnetic resonance imaging, and prostate-specific membrane antigen positron emission tomography/computed tomography in identifying patients with adverse prostate cancer pathology.

Approach:

Study Design: Retrospective evaluation of 413 patients who underwent radical prostatectomy for prostate cancer, assessing clinical and imaging variables.
Patient Characteristics: Median age of patients was 64.9 years; all patients underwent prostate biopsy.
Adverse Pathology Definition: Defined as International Society of Urological Pathologists grade 3 or higher disease and/or extraprostatic disease of pT3 or higher or pN1.

Key Findings:

60% of patients had adverse pathology at radical prostatectomy.
Adverse pathology rates were 48% for PSAD of 0.15 or lower and 72% for PSAD greater than 0.15.
80% of patients with PI-RADS 5 findings had adverse pathology.
The triple-positive profile (PSAD > 0.15, PI-RADS 5, PRIMARY 5) had 100% specificity and positive predictive value, but only 9% sensitivity.

Interpretation:

The combination of PSAD, mpMRI, and PSMA PET/CT may help define a highly selected population for prospective investigation of biopsy-sparing strategies.

Limitations:

Retrospective design with potential selection bias and unmeasured confounding.
Highly selected and homogeneous patient population.
Single-center design may limit generalizability.
External validation needed before adoption in prospective studies.

Conclusion:

The study identifies a specific subgroup of patients associated with adverse pathology using a combination of imaging and clinical parameters, warranting further investigation.