Diagnosis of Prostate Cancer in Patients with Prostate-Specific Antigen (PSA) in the Gray Area: Construction of 2 Predictive Models

Abstract

Background Two diagnostic models of prostate cancer (PCa) and clinically significant prostate cancer (CS-PCa) were established using clinical data of among patients whose prostate-specific antigen (PSA) levels are in the gray area (4.0–10.0 ng/ml). Material/Methods Data from 181 patients whose PSA levels were in the gray area were retrospectively analyzed, and the following data were collected: age, digital rectal examination, total PSA, PSA density (PSAD), free/total PSA (f/t PSA), transrectal ultrasound, multiparametric magnetic resonance imaging (mpMRI), and pathological reports. Patients were diagnosed with benign prostatic hyperplasia (BPH) and PCa by pathology reports, and PCa patients were separated into non-clinically significant PCa (NCS-PCa) and CS-PCa by Gleason score. Afterward, predictor models constructed by above parameters were researched to diagnose PCa and CS-PCa, respectively. Results According to the analysis of included clinical data, there were 109 patients with BPH, 44 patients with NCS-PCa, and 28 patients with CS-PCa. Regression analysis showed PCa was correlated with f/t PSA, PSAD, and mpMRI ( P <0.01), and CS-PCa was correlated with PSAD and mpMRI ( P <0.01). The area under the receiver operating characteristic curves of 2 models for PCa (sensitivity=73.64%, specificity=64.23%) and for CS-PCa (sensitivity=71.41%, specificity=81.82%) were 0.79 and 0.87, respectively. Conclusions The prediction models had satisfactory diagnostic value for PCa and CS-PCa among patients with PSA in the gray area, and use of these models may help reduce overdiagnosis.

Lncap-AI prostate cancer cell line establishment by Flutamide and androgen-free environment to promote cell adherent

“…Prostate cancer (PCa) is the world’s top 10 malignancy disease among men which causes leading to male-related cancer death in most countries [ 1 ]. The earlier stage of PCa can be diagnosed by magnetic resonance imaging technology and with the popularization of early prostate-specific antigen (PSA) screening [ 2 ]. At this time, the tumor is also confined to the prostate tissue and could achieve a good result using surgery and radiation therapy [ 3 ].…”

Patients With “Gray Zone” PSA Levels: Application of Prostate MRI and MRS in the Diagnosis of Prostate Cancer

“…The minimum time interval between MRI and reference standard was 1 day and the maximum was 4.9 months. However, 14 studies did not report the interval between MRI and reference standard ,17,19,21,22,24,26,29,30,32–36 …”

“…With regard to study objectives, 6 of the 23 (26.1%) studies 19,21,30,37–39 focused on the role of MRI or MRS in guiding prostate biopsy, and the remaining studies focused on the applicability of MRI or MRS for predicting prostate biopsy results. Eleven articles further investigated the detection of clinically significant PCa (csPCa) 24–26,31,33–35,37,38 or high‐grade PCa (HGPCa) 29,32 by MRI or MRS, which showed large heterogeneity across studies.…”

“…Table 1 shows the basic characteristics of 23 articles included in this review. The study sample size ranged from 26 16 to 2426 17 patients having the age ranging from 34 to 91 years with the reported mean (median) age ranging from 61.5 18 to 75 19 years. In terms of study design, 6 of the 23 (26.1%) studies 16,[20][21][22][23][24] were prospective and 15 of the 23 (65.2%), 17,19,[25][26][27][28][29][30][31][32][33][35][36][37] were retrospective.…”

“…However, 14 studies did not report the interval between MRI and reference standard. , 17,19,21,22,24,26,29,30,[32][33][34][35][36] For defining the criteria of PSA within the gray zone, a previous study 16 adopted European guidelines that set the range of PSA levels within the gray zone from 2.5 to 10.0 ng/mL. This is inconsistent with the range of 4.0-10.0 ng/mL considered in other studies.…”