Development and validation of a nomogram for predicting prostate cancer in men with prostate-specific antigen grey zone based on retrospective analysis of clinical and multi-parameter magnetic resonance imaging/transrectal ultrasound fusion-derived data

Ding, Zhongxiang; Wu, Huaiyu; Song, Di; Tian, Hongtian; Ye, Xiuqin; Liang, Weiyu; Jiao, Yang; Hu, Jintao; Xu, Jinfeng; Dong, Fajin

doi:10.21037/tau-20-1154

Cited by 6 publications

(4 citation statements)

References 51 publications

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“…Earlier research found that when PSA was in the diagnostic gray zone, PI-RADS had a better predictive ability than %fPSA and PSAD to avoid unnecessary prostate biopsies in patients, and PI-RADS score was complementary to PSAD and%fPSA. 30 , 35 , 36 Xu et al . 30 discovered that PI-RADS score of 4 was the best threshold for predicting csPCa, with a relatively low NPV of 0.716.…”

Section: Discussionmentioning

confidence: 99%

Combining clinical parameters and multiparametric magnetic resonance imaging to stratify biopsy-naïve men for an optimum diagnostic strategy with prostate-specific antigen 4 ng ml−1 to 10 ng ml−1

Zhang

Lin

et al. 2022

Asian Journal of Andrology

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We attempted to perform risk categories based on the free/total prostate-specific antigen ratio (%fPSA), prostate-specific antigen (PSA) density (PSAD, in ng ml−2), and multiparametric magnetic resonance imaging (mpMRI) step by step, with the goal of determining the best clinical diagnostic strategy to avoid unnecessary tests and prostate biopsy (PBx) in biopsy-naïve men with PSA levels ranging from 4 ng ml−1 to 10 ng ml−1. We included 439 patients who had mpMRI and PBx between August 2018 and July 2021 (West China Hospital, Chengdu, China). To detect clinically significant prostate cancer (csPCa) on PBx, receiver-operating characteristic (ROC) curves and their respective area under the curve were calculated. Based on %fPSA, PSAD, and Prostate Imaging-Reporting and Data System (PI-RADS) scores, the negative predictive value (NPV) and positive predictive value (PPV) were calculated sequentially. The optimal %fPSA threshold was determined to be 0.16, and the optimal PSAD threshold was 0.12 for %fPSA ³0.16 and 0.23 for %fPSA <0.16, respectively. When PSAD <0.12 was combined with patients with %fPSA ³0.16, the NPV of csPCa increased from 0.832 (95% confidence interval [CI]: 0.766–0.887) to 0.931 (95% CI: 0.833–0.981); the detection rate of csPCa was similar when further stratified by PI-RADS scores (P = 0.552). Combining %fPSA <0.16 with PSAD ³0.23 ng ml−2 predicted significantly more csPCa patients than those with PSAD <0.23 ng ml−2 (58.4% vs 26.7%, P < 0.001). Using PI-RADS scores 4 and 5, the PPV was 0.739 (95% CI: 0.634–0.827) when further stratified by mpMRI results. In biopsy-naïve patients with PSA level of 4–10 ng ml−1, stratification of %fPSA and PSAD combined with PI-RADS scores may be useful in the decision-making process prior to undergoing PBx.

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Section: Discussionmentioning

confidence: 99%

Combining clinical parameters and multiparametric magnetic resonance imaging to stratify biopsy-naïve men for an optimum diagnostic strategy with prostate-specific antigen 4 ng ml−1 to 10 ng ml−1

Zhang

Lin

et al. 2022

Asian Journal of Andrology

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“…In clinical practice, especially for nations with lower prostate cancer incidence rates, the prostate volume should be considered when counseling patients regarding their prostate cancer risks. 27 Our results highlight the significance of prebiopsy MRI, indicating that PI-RAD scores help decide on biopsy and prognosis of prostate cancer.…”

Section: Nomograms Have Been Developed and Validated In Previousmentioning

confidence: 58%

“…Based on 345 cases of grey zone, Fang et al 26 established a score for prostate volume, age, MRI, and DRE that had good prediction accuracy for high‐grade prostate cancer. Higher PI‐RAD scores occupied the second rank after lower free PSA/total prostate‐specific antigen (tPSA) ratio, and prostate volume in the nomogram forecasting the possibility of prostate cancer, in the study conducted by Ding et al 27 …”

Section: Discussionmentioning

confidence: 99%

Development and internal validation of a nomogram predicting significant prostate cancer: Is it clinically applicable in low prevalent prostate cancer countries? A multicenter study

Arafa,

Farhat,

Khan

et al. 2023

The Prostate

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BackgroundAccurately identifying aggressive prostate tumors and studying them as a separate outcome are urgently needed. Nomogram is a predictive tool using an algorithm, it has been widely applied in clinical practice to predict prognosis. We aimed to develop and internally validate a nomogram predicting clinically significant prostate cancer (csPCa).MethodsData were retrieved from the records of the two main hospitals in Riyadh, during the period 2019–2022. Significant variables associated with csPCa cases were used to develop and internally validate a novel nomogram, utilizing the C index, and calibration curves. Decision curve analysis (DCA) was used to assess its clinical utility.ResultsProstate imaging reporting and data system (PI‐RADS), smaller prostate volume, and prostate‐specific antigen (PSA) > 10 ng/mL were significantly associated with the risk csPCa, respectively. The model developed by the nomogram showed an excellent accuracy for csPCa discrimination, as indicated by area under the curve (0.83), and calibration curves. DCA showed that our model was superior and surpassed all other models with a larger net benefit for various threshold probabilities. Based on our model, at a probability threshold of 30%, biopsying patients is the equivalent of a strategy that led to an absolute 5% reduction in the number of biopsies without missing any csPCa.ConclusionThe developed nomogram consisting of PI‐RAD, total PSA, and prostate volume showed a robust predictive capacity for csPCa before prostate biopsy that may be valuable for clinical judgment to prevent needless biopsy. Yet, the small percentage (5%) of yielded unnecessary biopsies that could be saved by using such a model, cast an important question on its merit and clinical applicability.

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“…Comparing with the traditional strain elasticity, EQS has higher accuracy and better repeatability. Our previous research showed that the EQS could improve the accuracy of diagnosing, grading PCa (14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Assessment of elastographic Q-analysis score combined with Prostate Imaging-Reporting and Data System (PI-RADS) based on transrectal ultrasound (TRUS)/multi-parameter magnetic resonance imaging (MP-MRI) fusion-guided biopsy in differentiating benign and malignant prostate

Tian

Ding

et al. 2022

Quant Imaging Med Surg

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Background: Magnetic resonance imaging (MRI) has advantages in the diagnosis of prostate diseases, but there is also overdiagnosis. We compensate for this with fusion imaging and elastography. In this study, we want to evaluate Elastographic Q-analysis score (EQS) combined with Prostate Imaging Reporting and Data System (PI-RADS), based on transrectal ultrasound (TRUS)/multi-parameter magnetic resonance imaging (MP-MRI) fusion biopsy in differentiating benign and malignant prostate lesions.Methods: A total of 296 patients with 318 prostate lesions who underwent TRUS/MP-MRI fusion biopsy between October 2017 and October 2019 were retrospectively analysed. The performance of the EQS was evaluated on the sites of the suspicious areas of MP-MRI. The cut-off value of EQS was obtained according to receiver operating characteristic (ROC) curve, which was used to upgrade and downgrade the PI-RADS scores. The area under the curve (AUC), integrated discrimination improvement, and decision curve analysis were used to assess the new PI-RADS performance.Results: In total, 318 MP-MRI suspicious prostate lesions (94 malignant vs. 224 benign lesions). The EQS optimal threshold was 1.85, and the AUC was 0.816. All cases were constructed three models by using 1.85 as the cut-off value: upgrade-PI-RADS, downgrade-PI-RADS and complex-PI-RADS. The AUC of PI-RADS, upgrade-PI-RADS, downgrade-PI-RADS and complex-PI-RADS were 0.869, 0.867, 0.872 and 0.873 respectively. The diagnostic coincidence rate of PI-RADS was increased from 0.667 to 0.874 by using strain elastography, among which the diagnostic rate of prostate cancer was increased from 0.557 to 0.806, and the diagnostic rate of non-prostate cancer was increased from 0.775 to 0.967. The integrated discrimination improvement indicated that downgrade-PI-RADS had a better diagnostic capability (P<0.05). The net benefit of all models, which downgrade-PI-RADS can maximize the net benefit value of patients by decision curve analysis. Conclusions:The combination of PI-RADS and EQS with TRUS/MP-MRI fusion, particularly downgrade-PI-RADS, can reduce unnecessary biopsy procedures and prevent overdiagnosis.

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Development and validation of a nomogram for predicting prostate cancer in men with prostate-specific antigen grey zone based on retrospective analysis of clinical and multi-parameter magnetic resonance imaging/transrectal ultrasound fusion-derived data

Cited by 6 publications

References 51 publications

Combining clinical parameters and multiparametric magnetic resonance imaging to stratify biopsy-naïve men for an optimum diagnostic strategy with prostate-specific antigen 4 ng ml−1 to 10 ng ml−1

Combining clinical parameters and multiparametric magnetic resonance imaging to stratify biopsy-naïve men for an optimum diagnostic strategy with prostate-specific antigen 4 ng ml−1 to 10 ng ml−1

Development and internal validation of a nomogram predicting significant prostate cancer: Is it clinically applicable in low prevalent prostate cancer countries? A multicenter study

Assessment of elastographic Q-analysis score combined with Prostate Imaging-Reporting and Data System (PI-RADS) based on transrectal ultrasound (TRUS)/multi-parameter magnetic resonance imaging (MP-MRI) fusion-guided biopsy in differentiating benign and malignant prostate

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