USC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Int Braz J Urol. 2024 May-Jun;50(3):319-334. doi: 10.1590/S1677-5538.IBJU.2024.0084.
To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx).
We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC.
Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75.
Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI.
建立列线图模型以预测在接受多参数磁共振成像（mpMRI）检查且无前列腺癌可疑表现、前列腺影像报告和数据系统（PI-RADS）评分 1-2 分（mpMRI 阴性）、行前列腺穿刺活检（PBx）的男性中不存在临床显著前列腺癌（CSPCa）的概率。
我们纳入了连续接受 3T mpMRI 检查并因前列腺癌可疑而接受 PBx 或随访的患者。所有患者的 PI-RADS 评分均为 1-2 分（mpMRI 阴性）。CSPCa 的定义为 Gleason 分级≥2 级。采用向后消除法进行多变量逻辑回归分析。采用受试者工作特征曲线（ROC）下面积（AUROC）评估诊断效能。通过 1000 次 bootstrap 法进行内部验证，以估计校正后的 AUROC。
共有 327 例患者符合纳入标准。患者中位（IQR）年龄和前列腺特异性抗原密度（PSAD）分别为 64 岁（58-70）和 0.10ng/mL2（0.07-0.15）。活检史如下：117 例（36%）男性为首次 PBx，130 例（40%）曾行阴性 PBx，80 例（24%）曾行阳性 PBx。大多数患者为白人（65%），6%的男性自报为黑人。总体而言，44 例（13%）患者在 PBx 中诊断为 CSPCa。黑人、曾行阴性 PBx 和 PSAD≥0.15ng/mL2 是 PBx 中 CSPCa 的独立预测因素，并被纳入列线图。该列线图的 AUROC 为 0.78，校正后的 AUROC 为 0.75。
本列线图有助于评估 PI-RADS 评分 1-2 分的男性行 PBx 时 CSPCa 的个体概率，可能有助于识别那些可安全避免 PBx 的患者。即使在 PI-RADS 评分 1-2 分的情况下，黑人男性行 PBx 时 CSPCa 的风险也增加。
