@Article{cju.2026.074814,
AUTHOR = {Jingcheng Lyu, Ruiyu Yue, Ye Tian, Boyu Yang},
TITLE = {Analysis of risk factors for MRI-invisible prostate cancer—the significance of AGGF1 immunohistochemical detection and PSAD},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {33},
YEAR = {2026},
NUMBER = {2},
PAGES = {361--375},
URL = {http://www.techscience.com/CJU/v33n2/67027},
ISSN = {1488-5581},
ABSTRACT = { <b>Objectives:</b> Patients with a multi-parameter magnetic resonance imaging (mpMRI) prostate imaging report and data system (PI-RADS) score ≤ 3, but with clinically significant prostate cancer (CSPCa) detected by biopsy, are termed MRI-Invisible prostate cancer (MRI(-)PCa). This study aims to explore risk factors for MRI(-)PCa and identify immunohistochemical indicators with predictive significance. <b>Methods:</b> A retrospective analysis was conducted on 376 patients with PI-RADS score ≤ 3 who underwent 24-needle systematic prostate biopsy at Beijing Friendship Hospital, Capital Medical University (January 2015 to October 2025). Clinical data, imaging data, and Angiogenic factor with G and FHA domain 1 (AGGF1) immunohistochemical results were collected. Patients were grouped into CSPCa (n = 102) and non-CSPCa (n = 274). <i>t</i>-tests, rank sum tests, and <i>χ</i><sup>2</sup> tests were used for univariate analysis, followed by multivariate Logistic regression to determine independent risk factors. Receiver Operating Characteristic (ROC) curves were drawn. Subgroup analyses were conducted based on prostate-specific antigen (PSA) status and PI-RADS score using the same statistical methods. Moreover, we also used the Kruskal-Wallis test to compare the differences in AGGF1 expression percentages across different Gleason score groups according to ISUP in CSPCa patients. <b>Results:</b> Multivariate Logistic regression analysis showed that prostate-specific antigen density (PSAD) [OR: 0.971, 95%CI: 0.952, 0.991] and high expression of AGGF1 [OR: 1.065, 95%CI: 1.022, 1.109] were independent risk factors for MRI(-)PCa (<i>p</i> &lt; 0.05). Meanwhile, when the PSAD of the patient is more than 0.25 ng/mL/cm<sup>3</sup>, it is necessary to be more suspicious that the patient may have prostate cancer (<i>p</i> &lt; 0.05), and an AGGF1 immunohistochemical analysis should be conducted after the biopsy. In the PSA-negative subgroup, only high AGGF1 expression was an independent risk factor (<i>p</i> &lt; 0.05). In the PSA-positive subgroup, PSAD [OR: 0.500, 95%CI: 0.279, 0.895] and AGGF1 [OR: 1.064, 95%CI: 1.037, 1.092] results were independent risk factors (<i>p</i> &lt; 0.05). In subgroup analyses for PI-RADS 1-2 and PI-RADS 3, both PSAD and AGGF1 were accurate predictors of CSPCa (<i>p</i> &lt; 0.05). Among all CSPCa patients, in the Gleason score 3 + 3 group, the average AGGF1 expression percentage of the patients was 48.60% ± 11.03%, which was significantly lower than that of the Gleason score 4 + 3 group (61.00% ± 6.12%) and the Gleason score 4 + 4 group (71.01% ± 4.46%), and the differences were statistically significant (<i>p</i> &lt; 0.001). <b>Conclusions:</b> For patients with a PI-RADS score ≤ 3, attention should be paid to PSAD before biopsy, especially for those patients with PSAD &gt; 0.25 ng/mL/cm<sup>3</sup>, not just PSA levels. After biopsy, AGGF1 immunohistochemical staining can be supplemented to help determine the risk and the malignancy of CSPCa.},
DOI = {10.32604/cju.2026.074814}
}