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Ali A, Du Feu A, Oliveira P, Choudhury A, Bristow RG, Baena E. Prostate zones and cancer: lost in transition? Nat Rev Urol 2022; 19:101-115. [PMID: 34667303 DOI: 10.1038/s41585-021-00524-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 12/16/2022]
Abstract
Localized prostate cancer shows great clinical, genetic and environmental heterogeneity; however, prostate cancer treatment is currently guided solely by clinical staging, serum PSA levels and histology. Increasingly, the roles of differential genomics, multifocality and spatial distribution in tumorigenesis are being considered to further personalize treatment. The human prostate is divided into three zones based on its histological features: the peripheral zone (PZ), the transition zone (TZ) and the central zone (CZ). Each zone has variable prostate cancer incidence, prognosis and outcomes, with TZ prostate tumours having better clinical outcomes than PZ and CZ tumours. Molecular and cell biological studies can improve understanding of the unique molecular, genomic and zonal cell type features that underlie the differences in tumour progression and aggression between the zones. The unique biology of each zonal tumour type could help to guide individualized treatment and patient risk stratification.
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Affiliation(s)
- Amin Ali
- Prostate Oncobiology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Alexander Du Feu
- Prostate Oncobiology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Pedro Oliveira
- The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,The University of Manchester, Manchester Cancer Research Centre, Manchester, UK.,Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Robert G Bristow
- The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,The University of Manchester, Manchester Cancer Research Centre, Manchester, UK.,Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Esther Baena
- Prostate Oncobiology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK. .,Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.
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Jiang S, Huang Z, Liu B, Chen Z, Xu Y, Zheng W, Wen Y, Li M. MRI-Based Nomogram of Prostate Maximum Sectional Area and Its Zone Area for Prediction of Prostate Cancer. Front Oncol 2021; 11:708730. [PMID: 34568034 PMCID: PMC8458948 DOI: 10.3389/fonc.2021.708730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To reduce unnecessary prostate biopsies, we designed a magnetic resonance imaging (MRI)-based nomogram prediction model of prostate maximum sectional area (PA) and investigated its zone area for diagnosing prostate cancer (PCa). Methods MRI was administered to 691 consecutive patients before prostate biopsies from January 2012 to January 2020. PA, central gland sectional area (CGA), and peripheral zone sectional area (PZA) were measured on axial T2-weighted prostate MRI. Multivariate logistic regression analysis and area under the receiver operating characteristic (ROC) curve were performed to evaluate and integrate the predictors of PCa. Based on multivariate logistic regression coefficients after excluding combinations of collinear variables, three models and nomograms were generated and intercompared by Delong test, calibration curve, and decision curve analysis (DCA). Results The positive rate of PCa was 46.74% (323/691). Multivariate analysis revealed that age, PSA, MRI, transCGA, coroPZA, transPA, and transPAI (transverse PZA-to-CGA ratio) were independent predictors of PCa. Compared with no PCa patients, transCGA (AUC = 0.801) was significantly lower and transPAI (AUC = 0.749) was significantly higher in PCa patients. Both of them have a significantly higher AUC than PSA (AUC = 0.714) and PV (AUC = 0.725). Our best predictive model included the factors age, PSA, MRI, transCGA, and coroPZA with the AUC of 0.918 for predicting PCa status. Based on this predictive model, a novel nomogram for predicting PCa was conducted and internally validated (C-index = 0.913). Conclusions We found the potential clinical utility of transCGA and transPAI in predicting PCa. Then, we firstly built the nomogram based on PA and its zone area to evaluate its diagnostic efficacy for PCa, which could reduce unnecessary prostate biopsies.
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Affiliation(s)
- Shaoqin Jiang
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China.,Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhangcheng Huang
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Bingqiao Liu
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhenlin Chen
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yue Xu
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Wenzhong Zheng
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yaoan Wen
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Mengqiang Li
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
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Chang TH, Lin WR, Tsai WK, Chiang PK, Chen M, Tseng JS, Chiu AW. Zonal adjusted PSA density improves prostate cancer detection rates compared with PSA in Taiwanese males with PSA < 20 ng/ml. BMC Urol 2020; 20:151. [PMID: 33028274 PMCID: PMC7542736 DOI: 10.1186/s12894-020-00717-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The current study aimed to compare the efficacy of transition zone PSA density (TZPSAD) with traditional PSA and PSA density (PSAD), for the diagnosis of prostate cancer (PCa) in Taiwanese males. METHODS Men with PSA between 4.0 and 20.0 ng/ml who underwent a transrectal ultrasound (TRUS) guided prostate biopsy between the studied period were retrospectively identified. The demographic data, PSAD and TZPSAD were calculated in all patients. Receiver operating characteristic (ROC) curves were used to analyze the accuracy of a positive PCa diagnosis. RESULTS The area under the ROC (AUC) was 0.615, 0.748 and 0.746 for PSA, PSAD and TZPSAD, respectively. The best cut-off of value for TZPSAD in predicting PCa in men with a PSA of 4.0-10.0 ng/ml was 0.367 ng/ml/ml with a sensitivity of 50% and a specificity of 77.5%. In men with a PSA of 10.1-20.0 ng/ml, the best cut-off value was 0.454 ng/ml, with a sensitivity of 74.8% and specificity of 70.9%. CONCLUSION The use of TZPSAD can improve the efficiency and specificity of PSA for the diagnosis of PCa in Taiwanese men with PSA 4.0-20.0 ng/ml. TZPSAD efficiency was similar to PSAD but TZPSAD had better cancer specificity.
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Affiliation(s)
- Tsung-Hsin Chang
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, 10449, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, 10449, Taipei, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, 10449, Taipei, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan
| | - Pai-Kai Chiang
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, 10449, Taipei, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, 10449, Taipei, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, No.92, Shengjing Road, Beitou District, Taipei, 11272, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, 10449, Taipei, Taiwan.
| | - Allen W Chiu
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, 10449, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, No.145, Zhengzhou Rd., Datong Dist., Taipei, 10341, Taiwan
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