Bioelectric Impedance Analysis Test Improves the Detection of Prostate Cancer in Biopsy Candidates: A Multifeature Decision Support System

Abstract

Prostate cancer (PCa) gold-standard diagnosis relies on prostate biopsy, which is currently overly recommended since other available noninvasive tools such as prostate-specific antigen (PSA) multiparametric MRI (mMRI) showed low diagnostic accuracy or high costs, respectively. The aim of the study was to determine the accuracy of a novel Bioelectric Impedance Analysis (BIA) test endorectal probe for the selection of patients candidate to prostate biopsy and in particular the clinical value of three different parameters such as resistance (R), reactance (Xc), and phase angle (PA) degree. One-hundred twenty-three consecutive candidates to prostate biopsy and 40 healthy volunteers were enrolled. PSA and PSA density (PSAD) determinations, Digital Rectal Examination (DRE), and the novel BIA test were analyzed in patients and controls. A 16-core prostate biopsy was performed after a mMRI test. The study endpoints were to determine accuracy of BIA test in comparison with PSA, PSAD levels, and mMRI and obtain prostate cancer (PCa) prediction by BIA test. The Mann-Whitney U-test, the Wilkoxon rank test, and the Holm-Bonferroni’s method were adopted for statistical analyses, and a computational approach was also applied to differentiate patients with PCa from those with benign disease. Combined PSA, PSAD, DRE, and trans-rectal ultrasound test failed to discern patients with PCa from those with benign disease (62.86% accuracy). mMRI PIRADS ≥3 showed a sensitivity of 83% and a specificity of 59%. The accuracy in discerning PCa increased up to 75% by BIA test (sensitivity 63.33% and specificity 83.75%). The novel finger probe BIA test is a cheap and reliable test that may help to improve clinical multifeature noninvasive diagnosis for PCa and reduce unnecessary biopsies.

Phase angle and cellular health: inflammation and oxidative damage

“…Two studies explored the effectiveness of localized BIA and its PhA as a screening and prognostic tool for patients with prostate cancer [ 103 , 104 ]. Tyagi et al demonstrated that low PhA allowed discriminating prostate cancer patients using BIA electrodes on the right upper and right lower limb and a multifrequency BIA (QuadScan 4000 (Bodystat®; Isle of Man) [ 103 ].…”

“…In the other study, four electrodes were placed around the prostate area and a single frequency BIA (BIA 101 ASE®; Akern Srl, Italy) was used to measure PhA values in individuals with prostate cancer, benign prostatic disease, and healthy volunteers. Although Xc and R values differed between studied groups, PhA had a good sensitivity (0.925) but a poor specificity (0.200) to diagnose patients with prostate cancer [ 104 ]. Although none of these studies have evaluated the presence of inflammation, it is well known that the inflammatory state is associated with cancer, muscle damage and wound healing [ 3 , 105 , 106 ].…”