Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America.
Department of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
PLoS One. 2018 Aug 9;13(8):e0201384. doi: 10.1371/journal.pone.0201384. eCollection 2018.
To evaluate the performance of mpMRI and the 4Kscore test together for the detection of significant prostate cancer. Material and methods We selected a consecutive series of men who were referred for evaluation of prostate cancer at an academic institution and underwent mpMRI and the 4Kscore test. The primary outcome was the presence of Gleason 7 or higher cancer on biopsy of the prostate. We used logistic regression and Decision Curve Analysis to report the discrimination and clinical utility of using mpMRI and the 4Kscore test for prostate cancer detection. We modeled the probability of harboring a Gleason 7 or higher prostate cancer based on the 4Kscore test and mpMRI findings. Finally, we examined various combinations and sequences of mpMRI and the 4Kscore test and assessed the impact on biopsies avoided and cancers missed.
Among 300 men who underwent a 4Kscore test and mpMRI, 149 (49%) underwent a biopsy. Among those, 73 (49%) had cancer, and 49 (33%) had Gleason 7 cancer. The area under the curve (AUC) for using the 4Kscore test and mpMRI together 0.82 (0.75-0.89) was superior to using the 4Kscore 0.70 (0.62-0.79) or mpMRI 0.74 (0.66-0.81) individually (p = 0.001). Similarly, decision analysis revealed the highest net benefit was achieved using both tests.
The 4Kscore test and mpMRI results provide independent, but complementary, information that enhances the prediction of higher-grade prostate cancer and improves patient's selection for a prostate biopsy. Prospective trials are required to confirm these findings.
评估 mpMRI 和 4Kscore 测试联合用于检测显著前列腺癌的性能。
我们选择了一系列连续就诊于学术机构评估前列腺癌的男性，他们接受了 mpMRI 和 4Kscore 测试。主要结局是前列腺活检存在 Gleason 7 或更高分级的癌症。我们使用逻辑回归和决策曲线分析来报告使用 mpMRI 和 4Kscore 测试检测前列腺癌的鉴别和临床效用。我们根据 4Kscore 测试和 mpMRI 结果建立了存在 Gleason 7 或更高分级前列腺癌的概率模型。最后，我们检查了 mpMRI 和 4Kscore 测试的各种组合和顺序，并评估了对避免活检和遗漏癌症的影响。
在接受 4Kscore 测试和 mpMRI 的 300 名男性中，有 149 名（49%）接受了活检。其中，73 名（49%）患有癌症，49 名（33%）患有 Gleason 7 级癌症。联合使用 4Kscore 测试和 mpMRI 的曲线下面积（AUC）为 0.82（0.75-0.89），优于单独使用 4Kscore 0.70（0.62-0.79）或 mpMRI 0.74（0.66-0.81）（p=0.001）。同样，决策分析显示，使用这两种测试可获得最高的净收益。
4Kscore 测试和 mpMRI 结果提供了独立但互补的信息，增强了对高级别前列腺癌的预测，并改善了患者对前列腺活检的选择。需要前瞻性试验来证实这些发现。
