Chen Haojie, Qian Yuhang, Wu Yanyuan, Shi Bowen, Zhou Jiatong, Qu Fajun, Gu Zhengqin, Ding Jie, Yu Yongjiang
Department of Urology, School of Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.
Front Oncol. 2022 Apr 7;12:864111. doi: 10.3389/fonc.2022.864111. eCollection 2022.
Early screening of clinically significant prostate cancer (csPCa) may offer opportunities in revolutionizing the survival benefits of this lethal disease. We sought to introduce a modified prostate health index density (mPHI) model using imaging indicators and to compare its diagnostic performance for early detection of occult onset csPCa within the prostate-specific antigen (PSA) gray zone with that of PHI and PHID.
Between August 2020 and January 2022, a training cohort of 278 patients (total PSA 4.0-10.0 ng/ml) who were scheduled for a prostate biopsy were prospectively recruited. PHI and PHID were compared with mPHI for the diagnosis performance in identifying csPCa. Pathology outcomes from systematic prostate biopsies were considered the gold standard.
This model was tested in a training cohort consisting of 73 csPCa, 14 non-clinically significant prostate cancer(non-csPCa), and 191 benign prostatic hyperplasia (BPH) samples. In the univariate analysis for the PSA gray zone cohort, for overall PCa, the AUC of mPHI (0.856) was higher than PHI (0.774) and PHID (0.835). For csPCa, the AUC of mPHI (0.859) also surpassed PHI (0.787) and PHID (0.825). For detection of csPCa, compared with lower specificities from PHI and PHID, mPHI performed the highest specificity (76.5%), by sparing 60.0% of unnecessary biopsies at the cost of missing 11 cases of csPCa. The mPHI outperformed PHI and PHID for overall PCa detection. In terms of csPCa, mPHI exceeds diagnostic performance with a better net benefit in decision curve analysis (DCA) compared with PHI or PHID.
We have developed a modified PHI density (mPHI) model that can sensitively distinguish early-stage csPCa patients within the PSA gray zone.
ClinicalTrials.gov, NCT04251546.
早期筛查具有临床意义的前列腺癌（csPCa）可能为改善这种致命疾病的生存获益带来契机。我们试图引入一种使用影像学指标的改良前列腺健康指数密度（mPHI）模型，并将其在前列腺特异性抗原（PSA）灰色区域内早期检测隐匿性csPCa的诊断性能与前列腺健康指数（PHI）和前列腺健康指数密度（PHID）进行比较。
在2020年8月至2022年1月期间，前瞻性招募了278例计划进行前列腺活检的患者（总PSA为4.0 - 10.0 ng/ml）作为训练队列。将PHI和PHID与mPHI在识别csPCa的诊断性能方面进行比较。系统前列腺活检的病理结果被视为金标准。
该模型在一个由73例csPCa、14例非临床意义前列腺癌（non-csPCa）和191例良性前列腺增生（BPH）样本组成的训练队列中进行了测试。在PSA灰色区域队列的单因素分析中，对于总体前列腺癌，mPHI的曲线下面积（AUC）为0.856，高于PHI（0.774）和PHID（0.835）。对于csPCa，mPHI的AUC（0.859）也超过了PHI（0.787）和PHID（0.825）。对于csPCa的检测，与PHI和PHID较低的特异性相比，mPHI表现出最高特异性（76.5%），以漏诊11例csPCa为代价，避免了60.0%的不必要活检。在总体前列腺癌检测方面，mPHI优于PHI和PHID。就csPCa而言，在决策曲线分析（DCA）中，mPHI的诊断性能优于PHI或PHID，净获益更好。
我们开发了一种改良的PHI密度（mPHI）模型，该模型能够敏感地区分PSA灰色区域内的早期csPCa患者。
ClinicalTrials.gov，NCT04251546。
