A novel nomogram predicting the risk of positive biopsy for patients in the diagnostic gray area of prostate cancer

Abstract

The roles played by several inflammatory factors in screening for prostate cancer (PCa) among gray area patients, namely those with serum prostate-specific antigen (PSA) levels between 4 and 10 ng/ml, have not been completely identified, and few effective diagnostic nomograms have been developed exclusively for these patients. We aimed to investigate new independent predictors of positive biopsy (PB) results and develop a novel diagnostic nomogram for this group of patients. The independent predictors of PB results were identified, and a nomogram was constructed using multivariate logistic regression analysis based on a cohort comprising 401 Gy area patients diagnosed at Xijing Hospital (Xi’an, China) between January 2016 and December 2019. The predictive accuracy of the nomogram was assessed using the receiver operating characteristic curve, and the nomogram was calibrated by comparing the prediction with the observation. The performance of the nomogram was further validated using an independent cohort. Finally, lymphocyte-to-monocyte ratio (LMR) > 4.11 and red blood cell distribution width (RDW)-standard deviation (SD) > 42.9 fl were identified as independent protective predictors of PB results, whereas PSA density (PSAD) > 0.141 was identified as an independent risk predictor. The nomogram established using PSAD, LMR, and RDW-SD was perfectly calibrated, and its predictive accuracy was superior to that of PSAD in both internal and external validations (0.827 vs 0.769 and 0.765 vs 0.713, respectively). This study is the first to report the importance of LMR and RDW-SD in screening for PCa among gray area patients and to construct an exclusive nomogram to predict the individual risk of positive 13-core biopsy results in this group of patients. With superior performance over PSAD, our nomogram will help increase the accuracy of PCa screening, thereby avoiding unnecessary biopsy.

Lymphocyte‐to‐monocyte ratio is a predictor of clinically significant prostate cancer at prostate biopsy

“…Also, a recent in vitro study showed that the monocyte cell lines promoted the progression of prostate cancer cells through increased activity of monocyte chemotactic protein‐1 expression and nuclear factor kappa B activity 25 . In accordance with this accumulating evidence, the three recent studies reported that the lymphocyte‐to‐monocyte ratio was a significant factor that influenced the overall detection rate of prostate cancer 21–23 . However, the recent study by Li et al 11 reported that the lymphocyte‐to‐monocyte ratio was not associated with the overall detection rate of prostate cancer.…”

“…Also, to date, only a few studies involving small‐ or medium‐sized cohorts have tested the predictive role of lymphocyte‐to‐monocyte ratio in detecting prostate cancers. The studies have reported conflicting results 11,21–23 . Furthermore, there exist minimal data on the use of lymphocyte‐to‐monocyte ratio or eosinophil‐to‐lymphocyte as a significant factor influencing the detection of clinically significant cancers.…”

Preoperative red cell distribution width is associated with postoperative lymphovascular invasion in prostate cancer patients treated with radical prostatectomy: A retrospective study

“…( 42 ) reported that PCa patients with higher pre-treatment and post-treatment RDW levels had poorer 3-year overall survival and cancer-specific survival. One study reported that RDW could be used to develop a novel nomogram to predict the risk of positive biopsy for patients with gray area of PSA ( 43 ). In addition, Fukuokaya W, et al.…”

Preanalytical stability of molecular forms of prostate‐specific antigen in serum samples (PSA, free PSA, [−2]proPSA) and their impact on fPSA/tPSA ratio and PHI

“…Aggressive forms of PCa are mainly associated with lower fPSA percentage values. 11 fPSA is comprised of different molecular forms: alongside the intact form of PSA (iPSA) we find the precursor form proPSA, which is associated with cancer, and benign PSA (bPSA), associated primarily with BPH. 12 Different truncated forms of proPSA can be detected in the serum alongside the native form [−7]proPSA.…”