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Hamm CA, Baumgärtner GL, Padhani AR, Froböse KP, Dräger F, Beetz NL, Savic LJ, Posch H, Lenk J, Schallenberg S, Maxeiner A, Cash H, Günzel K, Hamm B, Asbach P, Penzkofer T. Reduction of false positives using zone-specific prostate-specific antigen density for prostate MRI-based biopsy decision strategies. Eur Radiol 2024; 34:6229-6240. [PMID: 38538841 PMCID: PMC11399225 DOI: 10.1007/s00330-024-10700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES To develop and test zone-specific prostate-specific antigen density (sPSAD) combined with PI-RADS to guide prostate biopsy decision strategies (BDS). METHODS This retrospective study included consecutive patients, who underwent prostate MRI and biopsy (01/2012-10/2018). The whole gland and transition zone (TZ) were segmented at MRI using a retrained deep learning system (DLS; nnU-Net) to calculate PSAD and sPSAD, respectively. Additionally, sPSAD and PI-RADS were combined in a BDS, and diagnostic performances to detect Grade Group ≥ 2 (GG ≥ 2) prostate cancer were compared. Patient-based cancer detection using sPSAD was assessed by bootstrapping with 1000 repetitions and reported as area under the curve (AUC). Clinical utility of the BDS was tested in the hold-out test set using decision curve analysis. Statistics included nonparametric DeLong test for AUCs and Fisher-Yates test for remaining performance metrics. RESULTS A total of 1604 patients aged 67 (interquartile range, 61-73) with 48% GG ≥ 2 prevalence (774/1604) were evaluated. By employing DLS-based prostate and TZ volumes (DICE coefficients of 0.89 (95% confidence interval, 0.80-0.97) and 0.84 (0.70-0.99)), GG ≥ 2 detection using PSAD was inferior to sPSAD (AUC, 0.71 (0.68-0.74)/0.73 (0.70-0.76); p < 0.001). Combining PI-RADS with sPSAD, GG ≥ 2 detection specificity doubled from 18% (10-20%) to 43% (30-44%; p < 0.001) with similar sensitivity (93% (89-96%)/97% (94-99%); p = 0.052), when biopsies were taken in PI-RADS 4-5 and 3 only if sPSAD was ≥ 0.42 ng/mL/cc as compared to all PI-RADS 3-5 cases. Additionally, using the sPSAD-based BDS, false positives were reduced by 25% (123 (104-142)/165 (146-185); p < 0.001). CONCLUSION Using sPSAD to guide biopsy decisions in PI-RADS 3 lesions can reduce false positives at MRI while maintaining high sensitivity for GG ≥ 2 cancers. CLINICAL RELEVANCE STATEMENT Transition zone-specific prostate-specific antigen density can improve the accuracy of prostate cancer detection compared to MRI assessments alone, by lowering false-positive cases without significantly missing men with ISUP GG ≥ 2 cancers. KEY POINTS • Prostate biopsy decision strategies using PI-RADS at MRI are limited by a substantial proportion of false positives, not yielding grade group ≥ 2 prostate cancer. • PI-RADS combined with transition zone (TZ)-specific prostate-specific antigen density (PSAD) decreased the number of unproductive biopsies by 25% compared to PI-RADS only. • TZ-specific PSAD also improved the specificity of MRI-directed biopsies by 9% compared to the whole gland PSAD, while showing identical sensitivity.
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Affiliation(s)
- Charlie A Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
| | - Georg L Baumgärtner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Konrad P Froböse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Dräger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Lynn J Savic
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Helena Posch
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Schallenberg
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Germany and PROURO, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Kuanar S, Cai J, Nakai H, Nagayama H, Takahashi H, LeGout J, Kawashima A, Froemming A, Mynderse L, Dora C, Humphreys M, Klug J, Korfiatis P, Erickson B, Takahashi N. Transition-zone PSA-density calculated from MRI deep learning prostate zonal segmentation model for prediction of clinically significant prostate cancer. Abdom Radiol (NY) 2024; 49:3722-3734. [PMID: 38896250 DOI: 10.1007/s00261-024-04301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To develop a deep learning (DL) zonal segmentation model of prostate MR from T2-weighted images and evaluate TZ-PSAD for prediction of the presence of csPCa (Gleason score of 7 or higher) compared to PSAD. METHODS 1020 patients with a prostate MRI were randomly selected to develop a DL zonal segmentation model. Test dataset included 20 cases in which 2 radiologists manually segmented both the peripheral zone (PZ) and TZ. Pair-wise Dice index was calculated for each zone. For the prediction of csPCa using PSAD and TZ-PSAD, we used 3461 consecutive MRI exams performed in patients without a history of prostate cancer, with pathological confirmation and available PSA values, but not used in the development of the segmentation model as internal test set and 1460 MRI exams from PI-CAI challenge as external test set. PSAD and TZ-PSAD were calculated from the segmentation model output. The area under the receiver operating curve (AUC) was compared between PSAD and TZ-PSAD using univariate and multivariate analysis (adjusts age) with the DeLong test. RESULTS Dice scores of the model against two radiologists were 0.87/0.87 and 0.74/0.72 for TZ and PZ, while those between the two radiologists were 0.88 for TZ and 0.75 for PZ. For the prediction of csPCa, the AUCs of TZPSAD were significantly higher than those of PSAD in both internal test set (univariate analysis, 0.75 vs. 0.73, p < 0.001; multivariate analysis, 0.80 vs. 0.78, p < 0.001) and external test set (univariate analysis, 0.76 vs. 0.74, p < 0.001; multivariate analysis, 0.77 vs. 0.75, p < 0.001 in external test set). CONCLUSION DL model-derived zonal segmentation facilitates the practical measurement of TZ-PSAD and shows it to be a slightly better predictor of csPCa compared to the conventional PSAD. Use of TZ-PSAD may increase the sensitivity of detecting csPCa by 2-5% for a commonly used specificity level.
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Affiliation(s)
- Shiba Kuanar
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jason Cai
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Hirotsugu Nakai
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Hiroki Nagayama
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Radiology, Nagasaki University, Nagasaki, Japan
| | | | - Jordan LeGout
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Adam Froemming
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Chandler Dora
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jason Klug
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA.
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Lu Y, Li B, Huang H, Leng Q, Wang Q, Zhong R, Huang Y, Li C, Yuan R, Zhang Y. Biparametric MRI-based radiomics classifiers for the detection of prostate cancer in patients with PSA serum levels of 4∼10 ng/mL. Front Oncol 2022; 12:1020317. [PMID: 36582803 PMCID: PMC9793773 DOI: 10.3389/fonc.2022.1020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/21/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose To investigate the predictive performance of the combined model by integrating clinical variables and radiomic features for the accurate detection of prostate cancer (PCa) in patients with prostate-specific antigen (PSA) serum levels of 4-10 ng/mL. Methods A retrospective study of 136 males (mean age, 67.3 ± 8.4 years) with Prostate Imaging-Reporting and Data System (PI-RADS) v2.1 category ≤3 lesions and PSA serum levels of 4-10 ng/mL were performed. All patients underwent multiparametric MRI at 3.0T and transrectal ultrasound-guided systematic prostate biopsy in their clinical workup. Radiomic features were extracted from axial T2-weighted images (T2WI) and apparent diffusion coefficient (ADC) maps of each patient using PyRadiomics. Pearson correlation coefficient (PCC) and recursive feature elimination (RFE) were implemented to identify the most significant radiomic features. Independent clinic-radiological factors were identified via univariate and multivariate regression analyses. Seven machine-learning algorithms were compared to construct a single-layered radiomic score (ie, radscore) and multivariate regression analysis was applied to construct the fusion radscore. Finally, the radiomic nomogram was further developed by integrating useful clinic-radiological factors and fusion radscore using multivariate regression analysis. The discriminative power of the nomogram was evaluated by area under the curve (AUC), DeLong test, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). Results The transitional zone-specific antigen density was identified as the only independent clinic-radiological factor, which yielded an AUC of 0.592 (95% confidence interval [CI]: 0.527-0.657). The ADC radscore based on six features and Naive Bayes achieved an AUC of 0.779 (95%CI: 0.730-0.828); the T2WI radscore based on 13 features and Support Vector Machine yielded an AUC of 0.808 (95%CI: 0.761-0.855). The fusion radscore obtained an improved AUC of 0.844 (95%CI: 0.801-0.887), which was higher than the single-layered radscores (both P<0.05). The radiomic nomogram achieved the highest value among all models (all P<0.05), with an AUC of 0.872 (95%CI: 0.835-0.909). Calibration curve showed good agreement and DCA together with CIC confirmed the clinical benefits of the radiomic nomogram. Conclusion The radiomic nomogram holds the potential for accurate and noninvasive identification of PCa in patients with PI-RADS ≤3 lesions and PSA of 4-10 ng/mL, which could reduce unnecessary biopsy.
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Affiliation(s)
- Yangbai Lu
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Binfei Li
- Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Hongxing Huang
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Qu Leng
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Qiang Wang
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Rui Zhong
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Yaqiang Huang
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Canyong Li
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Runqiang Yuan
- Department of Urology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | - Yongxin Zhang
- Department of Magnetic Resonance Imaging, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
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Banno T, Nakamura K, Kaneda Y, Ozaki A, Kouchi Y, Ohira T, Shimmura H. Detection rate and variables associated with incidental prostate cancer by holmium laser enucleation of the prostate. Int J Urol 2022; 29:860-865. [PMID: 35584916 DOI: 10.1111/iju.14917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/17/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Holmium laser enucleation of the prostate is well-established and effective for bladder outlet obstruction due to benign prostatic hyperplasia. The objective of this study was to examine the detection rate of incidental prostate cancer by holmium laser enucleation of the prostate and variables associated with them. METHODS A total of 612 patients were enrolled. We retrospectively examined the detection rate of incidental prostate cancer and perioperative variables associated with them. RESULTS Forty-nine of 612 patients were diagnosed with incidental prostate cancer. Univariate logistic regression analysis showed that higher prostate-specific antigen density (odds ratio 3.34, 95% confidence interval 1.02-10.94, P = 0.05), higher prostate-specific antigen density of the transition zone (odds ratio 2.28, 95% confidence interval 1.02-5.09, P = 0.04), and findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.71, 95% confidence interval 1.70-13.1, P = 0.003; transition zone: odds ratio 3.46, 95% confidence interval 1.74-6.86, P < 0.001; peripheral and transition zones: odds ratio 6.00, 95% confidence interval 1.51-23.8, P = 0.01) were significantly associated with incidental prostate cancer. Multivariate logistic regression analysis showed that findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.36, 95% confidence interval 1.49-12.8, P = 0.001; transition zone: odds ratio 3.54, 95% confidence interval 1.75-7.16, P < 0.001; peripheral and transition zones: odds ratio 6.14, 95% confidence interval 1.53-24.5, P = 0.01) was an independent risk factor for incidental prostate cancer. CONCLUSION The detection rate of incidental prostate cancer was 8.0%, and findings of the prostate cancer on magnetic resonance imaging were an independent predictive factor for incidental prostate cancer.
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Affiliation(s)
- Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
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Jin Y, Jung JH, Han WK, Hwang EC, Nho Y, Lee N, Yun JE, Lee KS, Lee SH, Lee H, Yu SY. Diagnostic accuracy of prostate-specific antigen below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting: A systematic review and meta-analysis. Investig Clin Urol 2022; 63:251-261. [PMID: 35534215 PMCID: PMC9091828 DOI: 10.4111/icu.20210429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/24/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A prostate-specific antigen (PSA) cutoff of 4 ng/mL has been widely used for prostate cancer screening in population-based settings. However, the accuracy of PSA below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting is inconclusive. We systematically reviewed the accuracy of PSA below 4 ng/mL cutoff in a hospital setting. MATERIALS AND METHODS We systematically reviewed the literature by searching major databases until March 2020, and a meta-analysis and quality assessment were performed. RESULTS A total of 11 studies were included at the completion of the screening process. The meta-analysis showed a sensitivity of 0.92 and a specificity of 0.16 for a PSA cutoff below 4 ng/mL. The area under the hierarchical summary receiver operating characteristic curve was 0.87, the positive likelihood ratio was 1.23, the negative likelihood ratio was 0.46, and the diagnostic odds ratio was 2.64. PSA sensitivities and specificities varied according to the cutoff range: 0.94 and 0.17 for 2 to 2.99 ng/mL, and 0.92 and 0.16 for 3 to 3.99 ng/mL, respectively. No significant differences in the sensitivity and specificity of PSA cutoffs in the range of 2 to 2.99 ng/mL and 3 to 3.99 ng/mL were found. CONCLUSIONS Although a PSA cutoff <3 ng/mL is relatively more sensitive and specific than PSA ≥3 ng/mL, no significant differences in sensitivity and specificity were found in the diagnosis of prostate cancer. Therefore, clinicians should choose an appropriate PSA cutoff on the basis of clinical circumstances and patients' characteristics.
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Affiliation(s)
- Yan Jin
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Yoonmi Nho
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Narae Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ji Eun Yun
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Sevrance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Urology, Kyung Hee University Medical Center, Seoul, Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su-Yeon Yu
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
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Liu J, Wang ZQ, Li M, Zhou MY, Yu YF, Zhan WW. Establishment of two new predictive models for prostate cancer to determine whether to require prostate biopsy when the PSA level is in the diagnostic gray zone (4-10 ng ml -1). Asian J Androl 2021; 22:213-216. [PMID: 31169140 PMCID: PMC7155794 DOI: 10.4103/aja.aja_46_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our goal was to establish two new predictive models of prostate cancer to determine whether to require a prostate biopsy when the prostate-specific antigen level is in the diagnostic gray zone. A retrospective analysis of 197 patients undergoing prostate biopsy with prostate-specific antigens between 4 and 10 ng ml−1 was conducted. Of these, 47 patients were confirmed to have cancer, while the remaining 150 patients were diagnosed with benign prostate disease after examining biopsy pathology. Two multivariate logistic regression models were established including age, prostate volumes, free/total prostate-specific antigen ratio, and prostate-specific antigen density using SPSS 19.0 to obtain the predicted probability and Logit P, and then, two receiver operating characteristic (ROC) curves were drawn to obtain the best cutoff value for prostate biopsy: one for the group of all the prostate cancers and one for the group of clinically significant prostate cancers. The best cutoff value for prostate biopsy was 0.25 from the multivariate logistic regression ROC curve model of all the prostate cancers, which gave a sensitivity of 75.4% and a specificity of 75.8%. The best cutoff value for prostate biopsy was 0.20 from the multivariate logistic regression model of clinically significant prostate cancers, which gave a sensitivity of 76.7% and a specificity of 80.1%. We identified the best cutoff values for prostate biopsy (0.25 for all prostate cancers and 0.20 for clinically significant prostate cancers) to determine whether to require prostate biopsy when the PSA level is in the diagnostic gray zone.
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Affiliation(s)
- Jun Liu
- Department of Ultrasonic Diagnosis, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Zhi-Qian Wang
- Department of Ultrasonic Diagnosis, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Min Li
- Department of Ultrasonic Diagnosis, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Ming-Yang Zhou
- Department of Ultrasonic Diagnosis, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Yi-Fei Yu
- Department of Ultrasonic Diagnosis, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Wei-Wei Zhan
- Department of Ultrasonic Diagnosis, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
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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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Sönmez G, Tombul ŞT, Demirtaş T, Öztürk F, Demirtaş A. A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range? Cureus 2019; 11:e6329. [PMID: 31857929 PMCID: PMC6901373 DOI: 10.7759/cureus.6329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective The gray-zone prostate-specific antigen (PSA) range is accepted to be 4-10 ng/ml and is considered to vary according to age. We aimed to investigate whether fusion prostate biopsy (FPB), which has been reported to have relatively higher cancer detection rates, has an effect on gray-zone PSA cut-off value. Material and methods This retrospective study included patients that underwent standard prostate biopsy (SPB) or multiparametric magnetic resonance imaging (MpMRI)-guided FPB (SPB+ targeted biopsy). All the patients included in the study were detected with a Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesion on MpMRI (the FPB group only). The demographics, clinical characteristics, and histopathological diagnoses were recorded for each patient. Results A total of 1,628 patients comprising 1,208 patients in the SPB group and 420 patients in the FPB group were included in the study. The mean PSA level was 9.75±6.68 ng/ml in the FBP group and 10.46±6.46 ng/ml in the SPB group (p=0.053). Prostate cancer (PCa) detection rate was significantly higher in the FPB group as compared to the SPB group (42.4% vs. 36.4%). The PSA cut-off value for PCa was 9.75 ng/ml (sensitivity and specificity, 81%) in the SPB group and was 7.55 ng/ml (sensitivity and specificity, 81% and 84%, respectively) in the FPB group. In the FPB group, the cancer detection rate among the patients with a PSA level of 7.55-10.00 ng/ml was 56.1%. Conclusion The results indicated that the introduction of FPB into clinical practice, which has relatively higher cancer detection rates, has further lowered the upper limit for gray-zone PSA.
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Affiliation(s)
| | | | - Türev Demirtaş
- History of Medicine and Ethics, Erciyes University, Kayseri, TUR
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Zheng S, Jiang S, Chen Z, Huang Z, Shi W, Liu B, Xu Y, Guo Y, Yang H, Li M. The roles of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen concentrations in predicting prostate cancer and high-risk prostate cancer. PLoS One 2019; 14:e0218645. [PMID: 31743339 PMCID: PMC6863612 DOI: 10.1371/journal.pone.0218645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/29/2019] [Indexed: 01/31/2023] Open
Abstract
Prostate biopsies are frequently performed to screen for prostate cancer (PCa) with complications such as infections and bleeding. To reduce unnecessary biopsies, here we designed an improved predictive model of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen (PSA) concentrations for diagnosing PCa and risk stratification. Multiparametric MRI administered to 422 consecutive patients before initial transrectal ultrasonography-guided 13-core prostate biopsies from January 2012 to March 2018 at Fujian Medical University Union Hospital. Univariate and multivariate logistic regression analyses and determination of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was performed to evaluate and integrate the predictors of PCa and high-risk prostate cancer (HR-PCa). The detection rates of PCa was 43.84% (185/422). And the detection rates of HR-PCa was 71.35% (132/185) in PCa patients. Multivariate analysis revealed that prostate volume(PV), PSA density(PSAD), transitional zone volume(TZV), PSA density of the transitional zone(PSADTZ), and MR were independent predictors of PCa and HR-PCa. PSA, peripheral zone volume(PZV) and PSA density of the peripheral zone(PSADPZ) were independent predictors of PCa but not HR-PCa. The AUC of our best predictive model including PSA + PV + PSAD + MR + TZV or PSA + PV + PSAD + MR + PZV was 0.906 for PCa. The AUC of the best predictive model of PV + PSAD + MR + TZV was 0.893 for HR-PCa. In conclusion, our results will likely improve the detection rate of prostate cancer, avoiding unnecessary prostate biopsies, and for evaluating risk stratification.
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Affiliation(s)
- Song Zheng
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Shaoqin Jiang
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhenlin Chen
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhangcheng Huang
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Wenzhen Shi
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Bingqiao Liu
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yue Xu
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yinan Guo
- Department of Nursing, Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Huijie Yang
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Mengqiang Li
- Laboratory of Urology, Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- * E-mail:
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Comparison of PSA-density of the transition zone and whole gland for risk stratification of men with suspected prostate cancer: A retrospective MRI-cohort study. Eur J Radiol 2019; 120:108660. [DOI: 10.1016/j.ejrad.2019.108660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/18/2019] [Accepted: 08/24/2019] [Indexed: 11/21/2022]
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