Lee Adrianna Jiaying, Wnorowski Amelia, Ye Nancy, Xu Linhan, Naslund Michael, Wood Bradford J, Merino Maria J, Turkbey Baris, Choyke Peter L, Pinto Peter A, Siddiqui M Minhaj
University of Maryland, Baltimore, MD, USA.
Baltimore VA Medical Center, Baltimore, MD, USA.
Curr Urol. 2022 Mar;16(1):38-43. doi: 10.1097/CU9.0000000000000069. Epub 2021 Dec 6.
Gleason score grading is a cornerstone of risk stratification and management of patients with prostate cancer (PCa). In this work, we derive and validate a nomogram that uses prostate multiparametric magnetic resonance imaging (MP-MRI) and clinical patient characteristics to predict biopsy Gleason scores (bGS).
A predictive nomogram was derived from 143 men who underwent MP-MRI prior to any prostate biopsy and then validated on an independent cohort of 235 men from a different institution who underwent MP-MRI for PCa workup. Screen positive lesions were defined as lesions positive on T2W and DWI sequences on MP-MRI. Prostate specific antigen (PSA) density, number of screen positive lesions, and MRI suspicion were associated with PCa Gleason score on biopsy and were used to generate a predictive nomogram. The independent cohort was tested on the nomogram and the most likely bGS was noted.
The mean PSA in the validation cohort was 9.25ng/mL versus 6.8ng/mL in the original cohort ( = 0.001). The distribution of Gleason scores between the 2 cohorts were not significantly different ( = 0.7). In the original cohort of men, the most probable nomogram generated Gleason score agreed with actual pathologic bGS findings in 61% of the men. In the validation cohort, the most likely nomogram predicted bGS agreed with actual pathologic bGS 51% of the time. The nomogram correctly identified any PCa versus non-PCa 63% of the time and clinically significant (Gleason score ≥ 7) PCa 69% of the time. The negative predictive value for clinically significant PCa using this prebiopsy nomogram was 74% in the validation group.
A preintervention nomogram based on PSA and MRI findings can help narrow down the likely pathologic finding on biopsy. Validation of the nomogram demonstrated a significant ability to correctly identify the most likely bGS. This feasibility study demonstrates the potential of a prebiopsy prediction of bGS and based on the high negative predictive value, identification of men who may not need biopsies, which could impact future risk stratification for PCa.
Gleason评分分级是前列腺癌（PCa）患者风险分层和管理的基石。在本研究中，我们推导并验证了一种列线图，该列线图使用前列腺多参数磁共振成像（MP-MRI）和临床患者特征来预测活检Gleason评分（bGS）。
从143名在进行任何前列腺活检之前接受MP-MRI检查的男性中推导预测列线图，然后在来自不同机构的235名接受MP-MRI检查以进行PCa评估的男性独立队列中进行验证。筛查阳性病变定义为MP-MRI上T2W和DWI序列呈阳性的病变。前列腺特异性抗原（PSA）密度、筛查阳性病变数量和MRI可疑程度与活检时的PCa Gleason评分相关，并用于生成预测列线图。对独立队列进行列线图测试并记录最可能的bGS。
验证队列中的平均PSA为9.25ng/mL，而原始队列中的平均PSA为6.8ng/mL（P = 0.001）。两个队列之间Gleason评分的分布没有显著差异（P = 0.7）。在原始男性队列中，列线图生成的最可能Gleason评分与61%男性的实际病理bGS结果一致。在验证队列中，列线图预测的最可能bGS与实际病理bGS在51%的时间内一致。列线图在63%的时间内正确识别了任何PCa与非PCa，在69%的时间内正确识别了具有临床意义（Gleason评分≥7）的PCa。在验证组中，使用该活检前列线图对具有临床意义的PCa的阴性预测值为74%。
基于PSA和MRI结果的干预前列线图有助于缩小活检时可能的病理结果范围。列线图的验证表明其具有正确识别最可能bGS的显著能力。这项可行性研究证明了活检前预测bGS的潜力，并且基于高阴性预测值，可以识别可能不需要活检的男性，这可能会影响未来PCa的风险分层。
