前列腺磁共振成像（MRI）在诊断过程中的使用出现了显著增加。通过从MRI计算前列腺体积，前列腺特异性抗原密度（PSAD）现已成为前列腺癌（PCa）风险分层的可用参数，尤其是在MRI阴性或疑似病灶不确定的患者中。本文旨在评估在前列腺活检前接受MRI的患者中，PSAD对临床意义明确的前列腺癌（CSPCa）的诊断表现。 根据首选报告系统性回顾与Meta分析（PRISMA）标准，两名研究员进行了系统性回顾。符合以下标准的研究（发表于2012年1月1日至2021年12月31日之间）被纳入研究：报告了在接受前列腺活检之前进行前列腺MRI和随后活检的男性中，PSAD（干预）用于CSPCa的诊断结果（结果），活检病理作为金标准进行比较（对照组）。 在PubMed、Scopus和Embase中共检索到1536篇论文。其中，248篇研究进行了详细审核，39篇符合资格。对于具有阳性MRI的患者，PSAD为0.1 ng/ml/ml时，汇总敏感性（SENS）和特异性（SPEC）分别为0.87和0.35；PSAD为0.15 ng/ml/ml时，汇总SENS和SPEC分别为0.74和0.61；PSAD为0.2 ng/ml/ml时，汇总SENS和SPEC分别为0.51和0.81。对于具有阴性MRI的患者，PSAD为0.1 ng/ml/ml时，汇总SENS和SPEC分别为0.85和0.36；PSAD为0.15 ng/ml/ml时，汇总SENS和SPEC分别为0.60和0.66；PSAD为0.2 ng/ml/ml时，汇总SENS和SPEC分别为0.33和0.84。在具有前列腺成像报告与数据系统（PI-RADS）3或Likert 3病灶的患者中，PSAD为0.1 ng/ml/ml时，汇总SENS和SPEC分别为0.87和0.39；PSAD为0.15 ng/ml/ml时，汇总SENS和SPEC分别为0.61和0.69；PSAD为0.2 ng/ml/ml时，汇总SENS和SPEC分别为0.42和0.82。对于具有阴性MRI的患者，如果PSAD为<0.15 ng/ml/ml，则CSPCa的后验概率为6%，如果PSAD为<0.10 ng/ml/ml，则该概率降至4%。 本系统性回顾定量评估了结合前列腺MRI的PSAD对CSPCa的诊断表现。结果表明，在具有阴性MRI和PI-RADS 3或Likert 3病灶的患者中，PSAD具有互补的表现和预测价值。将PSAD纳入前列腺活检的决策过程可能有助于改善风险调整护理。 在MRI使用增加的时代，前列腺特异性抗原密度是一个可使用的参数，用于临床意义明确的前列腺癌（CSPCa）的诊断。研究结果表明，如果PSAD<0.10 ng/ml/ml，则具有阴性活检前MRI或前列腺成像报告与数据系统（Likert）评分3病灶的患者患有CSPCa的可能性非常低（分别为4%或6%），这可能降低了这些患者进行活检的需求。由Elsevier B.V.出版。

There has been a dramatic increase in the use of prostate magnetic resonance imaging (MRI) in the diagnostic workup. With prostate volume calculated from MRI, prostate-specific antigen density (PSAD) now is a ready-to-use parameter for prostate cancer (PCa) risk stratification before prostate biopsy, especially among patients with negative MRI or equivocal lesions.In this review, we aimed to evaluate the diagnostic performance of PSAD for clinically significant prostate cancer (CSPCa) among patients who received MRI before prostate biopsy.Two investigators performed a systematic review according of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Studies (published between January 1, 2012, and December 31, 2021) reporting the diagnostic performance (outcomes) of PSAD (intervention) for CSPCa among men who received prebiopsy prostate MRI and subsequent prostate biopsy (patients), using biopsy pathology as the gold standard (comparison), were eligible for inclusion.A total of 1536 papers were identified in PubMed, Scopus, and Embase. Of these, 248 studies were reviewed in detail and 39 were qualified. The pooled sensitivity (SENS) and specificity (SPEC) for diagnosing CSPCa among patients with positive MRI were, respectively, 0.87 and 0.35 for PSAD of 0.1 ng/ml/ml, 0.74 and 0.61 for PSAD of 0.15 ng/ml/ml, and 0.51 and 0.81 for PSAD of 0.2 ng/ml/ml. The pooled SENS and SPEC for diagnosing CSPCa among patients with negative MRI were, respectively, 0.85 and 0.36 for PSAD of 0.1 ng/ml/ml, 0.60 and 0.66 for PSAD of 0.15 ng/ml/ml, and 0.33 and 0.84 for PSAD of 0.2 ng/ml/ml. The pooled SENS and SPEC among patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 or Likert 3 lesions were, respectively, 0.87 and 0.39 for PSAD of 0.1 ng/ml/ml, 0.61 and 0.69 for PSAD of 0.15 ng/ml/ml, and 0.42 and 0.82 for PSAD of 0.2 ng/ml/ml. The post-test probability for CSPCa among patients with negative MRI was 6% if PSAD was <0.15 ng/ml/ml and dropped to 4% if PSAD was <0.10 ng/ml/ml.In this systematic review, we quantitatively evaluated the diagnosis performance of PSAD for CSPCa in combination with prostate MRI. It demonstrated a complementary performance and predictive value, especially among patients with negative MRI and PI-RADS 3 or Likert 3 lesions. Integration of PSAD into decision-making for prostate biopsy may facilitate improved risk-adjusted care.Prostate-specific antigen density is a ready-to-use parameter in the era of increased magnetic resonance imaging (MRI) use in clinically significant prostate cancer (CSPCa) diagnosis. Findings suggest that the chance of having CSPCa was very low (4% or 6% for those with negative prebiopsy MRI or Prostate Imaging Reporting and Data System (Likert) score 3 lesion, respectively, if the PSAD was <0.10 ng/ml/ml), which may lower the need for biopsy in these patients.Published by Elsevier B.V.