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Young S, Gasparetto A, Jalaeian H, Golzarian J. Biomarkers in the setting of benign prostatic hyperplasia-induced lower urinary tract symptoms: what an interventional radiologist needs to know. Br J Radiol 2020; 93:20200484. [PMID: 32706988 DOI: 10.1259/bjr.20200484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With increasing evidence to support prostate artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH)-induced lower urinary tract symptoms (LUTS), Interventional Radiologists have begun to play an important role in the management of these patients. One area of knowledge needed when developing a PAE practice is knowledge of prostate-specific antigen (PSA) and other biomarkers utilized to detect prostate cancer in this population and what role they should play in the work up and follow-up of patients presenting with presumed BPH-induced LUTS. Furthermore, understanding how to evaluate presumed BPH-induced LUTS and stratify the risk of prostate cancer is an important skill to develop. The goal of this review is to provide Interventional Radiologists who have begun or aim to begin a PAE practice with the information they need to know regarding PSA levels and prostate cancer risk stratification for this patient population.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
| | - Alessandro Gasparetto
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami 1115 NW 14 St, Miami, FL, 33136, United States
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
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Adaptation of the prostate biopsy collaborative group risk calculator in patients with PSA less than 10 ng/ml improves its performance. Int Urol Nephrol 2020; 52:1811-1819. [PMID: 32468165 DOI: 10.1007/s11255-020-02517-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSES The prostate biopsy collaborative group risk calculator (PBCGRC) is a newly developed risk estimator for predicting prostate biopsy outcomes. However, its clinical usefulness is still unknown within the so-called gray area of PSA values. This study aimed to determine whether updating the PBCGRC improves its predictive performance for predicting any-grade and high-grade (HG), defined as biopsy Gleason score ≥ 7, prostate cancer (PCa) in patients with prostate-specific antigen (PSA) less than 10 ng/ml. METHODS The risk of any-grade and HGPCa was calculated using the PBCG risk calculation formulas updated by recalibration in the large, logistic recalibration and model revision. Predictive performances of the PBCGRC and the updated models were compared using discrimination, calibration, and clinical utility. RESULTS Within the study sample of 526 patients, PCa was detected in 193 (36.7%), and 78 (14.8%) of them had HGPCa. According to the calibration curves, the PBCGRC overestimated the risk of PCa. Predictive accuracy of the revised model was higher [the area under the receiver-operating characteristic curve (AUCs), 65.4% and 70.2%] than that of the PBCGRC (AUCs, 60.4% and 64.3%) for any-grade and HGPCa. The net benefit was greater for model revision in comparison with the original model. CONCLUSION The performance accuracy of PBCGRC for the prediction of any and HGPC in men undergoing prostate biopsy with PSA levels below 10 ng/ml is suboptimal. The model revision resulted with significant improvement in model performance. However, external validation of the revised model is necessary before its routine use in clinical practice.
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Shen P, Zhao J, Sun G, Chen N, Zhang X, Gui H, Yang Y, Liu J, Shu K, Wang Z, Zeng H. The roles of prostate-specific antigen (PSA) density, prostate volume, and their zone-adjusted derivatives in predicting prostate cancer in patients with PSA less than 20.0 ng/mL. Andrology 2017; 5:548-555. [PMID: 28409907 DOI: 10.1111/andr.12322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/16/2016] [Accepted: 12/03/2016] [Indexed: 02/05/2023]
Affiliation(s)
- P. Shen
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - J. Zhao
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - G. Sun
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - N. Chen
- Department of Pathology; West China Hospital; Sichuan University; Chengdu China
| | - X. Zhang
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - H. Gui
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - Y. Yang
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - J. Liu
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - K. Shu
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - Z. Wang
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - H. Zeng
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
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Peng Y, Shen D, Liao S, Turkbey B, Rais-Bahrami S, Wood B, Karademir I, Antic T, Yousef A, Jiang Y, Pinto PA, Choyke PL, Oto A. MRI-based prostate volume-adjusted prostate-specific antigen in the diagnosis of prostate cancer. J Magn Reson Imaging 2015; 42:1733-9. [PMID: 25946664 DOI: 10.1002/jmri.24944] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 04/23/2015] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To determine whether prostate-specific antigen (PSA) levels adjusted by prostate and zonal volumes estimated from magnetic resonance imaging (MRI) improve the diagnosis of prostate cancer (PCa) and differentiation between patients who harbor high-Gleason-sum PCa and those without PCa. MATERIALS AND METHODS This retrospective study was Health Insurance Portability and Accountability Act (HIPAA)-compliant and approved by the Institutional Review Board of participating medical institutions. T2 -weighted MR images were acquired for 61 PCa patients and 100 patients with elevated PSA but without PCa. Computer methods were used to segment prostate and zonal structures and to estimate the total prostate and central-gland (CG) volumes, which were then used to calculate CG volume fraction, PSA density, and PSA density adjusted by CG volume. These quantities were used to differentiate patients with and without PCa. Area under the receiver operating characteristic curve (AUC) was used as the figure of merit. RESULTS The total prostate and CG volumes, CG volume fraction, and PSA density adjusted by the total prostate and CG volumes were statistically significantly different between patients with PCa and patients without PCa (P ≤ 0.007). AUC values for the total prostate and CG volumes, and PSA density adjusted by CG volume, were 0.68 ± 0.04, 0.68 ± 0.04, and 0.66 ± 0.04, respectively, and were significantly better than that of PSA (P < 0.02), for differentiation of PCa patients from patients without PCa. CONCLUSION The total prostate and CG volumes estimated from T2 -weighted MR images and PSA density adjusted by these volumes can improve the effectiveness of PSA for the diagnosis of PCa and differentiation of high-Gleason-sum PCa patients from patients without PCa.
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Affiliation(s)
- Yahui Peng
- School of Electronic and Information Engineering, Beijing Jiaotong University, Beijing, China.,Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Dinggang Shen
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shu Liao
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradford Wood
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ibrahim Karademir
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Illinois, USA
| | - Ambereen Yousef
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Yulei Jiang
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L Choyke
- Diagnostic Radiology Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
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Prostate volumes derived from MRI and volume-adjusted serum prostate-specific antigen: correlation with Gleason score of prostate cancer. AJR Am J Roentgenol 2014; 201:1041-8. [PMID: 24147475 DOI: 10.2214/ajr.13.10591] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to study relationships between MRI-based prostate volume and volume-adjusted serum prostate-specific antigen (PSA) concentration estimates and prostate cancer Gleason score. MATERIALS AND METHODS The study included 61 patients with prostate cancer (average age, 63.3 years; range 52-75 years) who underwent MRI before prostatectomy. A semiautomated and MRI-based technique was used to estimate total and central gland prostate volumes, central gland volume fraction (central gland volume divided by total prostate volume), PSA density (PSAD; PSA divided by total prostate volume), and PSAD for the central gland (PSA divided by central gland volume). These MRI-based volume and volume-adjusted PSA estimates were compared with prostatectomy specimen weight and Gleason score by using Pearson (r) or Spearman (ρ) correlation coefficients. RESULTS The estimated total prostate volume showed a high correlation with reference standard volume (r = 0.94). Of the 61 patients, eight (13.1%) had a Gleason score of 6, 40 (65.6%) had a Gleason score of 7, seven (11.5%) had a Gleason score of 8, and six (9.8%) had a Gleason score of 9 for prostate cancer. The Gleason score was significantly correlated with central gland volume fraction (ρ = -0.42; p = 0.0007), PSAD (ρ = 0.46; p = 0.0002), and PSAD for the central gland (ρ = 0.55; p = 0.00001). CONCLUSION Central gland volume fraction, PSAD, and PSAD for the central gland estimated from MRI examinations show a modest but significant correlation with Gleason score and have the potential to contribute to personalized risk assessment for significant prostate cancer.
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Nicolaiew N, Ploussard G, Chun FKH, Xylinas E, Allory Y, Salomon L, de la Taille A. Prediction of the risk of harboring prostate cancer by a prebiopsy nomogram based on extended biopsy protocol. Urol Int 2013; 90:306-11. [PMID: 23295308 DOI: 10.1159/000345603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 11/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to build a nomogram allowing to predict the probability of prostate cancer (PC) after an initial 21-core biopsy and with readily available clinical data. METHODS 1,490 screened men who underwent an initial 21-core biopsy protocol were included. A multivariate logistic regression was realized including age, prostate volume, prostate-specific antigen (PSA) level, digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Receiver-operating characteristic estimates were used to quantify accuracy of each model. RESULTS PC was detected in 41.3% of the patients. Median PSA, age and prostate volume were 6.2 ng/ml (range 0.2-50), 64.6 years (range 33-87) and 40 ml (range 10-270), respectively. Abnormal TRUS findings were detected in 14.7% of patients. Age, PSA level, prostate volume, DRE and TRUS were significantly associated with PC (all p ≤ 0.004) in univariable logistic regression analysis. In multivariate logistic regression analysis, significant associations were found for age, PSA level, prostate volume and DRE. Predictive accuracy estimate of this model was equal to 0.70. TRUS was not an independent predictor of PC. CONCLUSIONS We constructed the first prebiopsy predictive nomogram based on an extended 21-core biopsy procedure with age, PSA level, DRE and prostate volume which are readily available clinical data to urologists.
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Nomura M, Ito K, Miyakubo M, Sekine Y, Tamura Y, Shimizu N, Aoki S, Suzuki K. Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy- and prostate volume-adjusted biopsy scheme. Prostate Cancer Prostatic Dis 2011; 15:202-9. [DOI: 10.1038/pcan.2011.62] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Development and External Validation of a Nomogram Predicting the Probability of Significant Gleason Sum Upgrading among Japanese Patients with Localized Prostate Cancer. Prostate Cancer 2011; 2011:754382. [PMID: 22110999 PMCID: PMC3216057 DOI: 10.1155/2011/754382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 10/11/2010] [Indexed: 11/18/2022] Open
Abstract
Objective. The aim of this study is to develop a prognostic model capable of predicting the probability of significant upgrading among Japanese patients.
Methods. The study cohort comprised 508 men treated with RP, with available prostate-specific antigen levels, biopsy, and RP Gleason sum values. Clinical and pathological data from 258 patients were obtained from another Japanese institution for validation.
Results. Significant Gleason sum upgrading was recorded in 92 patients (18.1%) at RP. The accuracy of the nomogram predicting the probability of significant Gleason sum upgrading between biopsy and RP specimens was 88.9%. Overall AUC was 0.872 when applied to the validation data set. Nomogram predictions of significant upgrading were within 7.5% of an ideal nomogram.
Conclusions. Nearly one-fifth of Japanese patients with prostate cancer will be significantly upgraded. Our nomogram seems to provide considerably accurate predictions regardless of minor variations in pathological assessment when applied to Japanese patient populations.
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