Improving the detection rate of prostate cancer in the gray zone of PI-RADS v2 and serum tPSA by using prostate-specific antigen–age volume

Lu, Yuan‐Fei; Zhang, Qian; Chen, Haiyan; Chen, Jie-Yu; Pan, Yao; Xu, Congcong; Xu, Jianxia; Yu, Ri‐Sheng

doi:10.1097/md.0000000000016289

Cited by 7 publications

(24 citation statements)

References 29 publications

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“…PI-RADS v2.0 using mpMRI, which has a superior image quality than TRUS, is used to diagnose prostate cancer. However, Lu et al [23] reported that MRI findings with a PI-RADS score of 3 or higher in patients with gray zone PSA level were at 38.2%, and the authors suggested using total PSA, PSAD, and PSA-age volume adjustments to improve the detection rate of prostate cancer in these patients.…”

Section: Logistic Regression Analysis According To Cut-off Values Of Various Parametersmentioning

confidence: 99%

Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

et al. 2021

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Background Serum prostate-specific antigen (PSA) is widely used in screening tests for prostate cancer. As the low specificity of PSA results in unnecessary and invasive prostate biopsies, we evaluated the clinical significance of various PSAs and PSA density (PSAD) related to peripheral zones in patients with gray zone PSA level (4–10 ng/mL). Methods A total of 1300 patients underwent transrectal ultrasonography-guided prostate biopsy from 2014 to 2019. Among them, 545 patients in the gray zone were divided into the prostate cancer diagnosis group and the non-prostate cancer diagnosis group, and PSA, relative extra transitional zone PSA (RETzPSA), estimated post holmium laser enucleation of the prostate PSA (EPHPSA), PSAD, peripheral zone PSA density (PZPSAD) and extra-transitional zone density (ETzD) were compared and analyzed using receiver-operating characteristics (ROC) analysis after 1:1 matching using propensity score. Results Area under the ROC curve values of PSA, EPHPSA, RETzPSA, PSA density, ETzD, and PZPSAD were 0.553 (95% CI: 0.495–0.610), 0.611 (95% CI: 0.554–0.666), 0.673 (95% CI: 0.617–0.725), 0.745 (95% CI: 0.693–0.793), 0.731 (95% CI: 0.677–0.780) and 0.677 (95% CI: 0.611–0.719), respectively. PSAD had 67.11% sensitivity, 71.71% specificity, and 70.34% positive predictive rate at 0.18 ng/mL/cc. ETzD had 69.08% sensitivity, 64.47% specificity, and 66.04% positive predictive rate at 0.04 ng/mL/cc. When the cut-off value of PSAD was increased to 0.18 ng/mL/cc, the best results were obtained with an odds ratio of 5.171 (95% CI: 3.171–8.432), followed by ETzD with 4.054 (95% CI: 2.513–6.540). Conclusions These results suggested that volume-adjusted parameters (ETzD and PSAD) might be more sensitive and accurate than various PSA in gray zone patients who required prostate biopsy to reduce unnecessary biopsy.

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Section: Logistic Regression Analysis According To Cut-off Values Of Various Parametersmentioning

confidence: 99%

Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

et al. 2021

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“…In terms of the pathological reference standard, all the studies employed TRUS-guided biopsy. Seven of these studies 20,23,28,29,31,34,36 also used cognitive MRI-TRUS fusion-guided biopsies. In addition, nine articles [24][25][26]28,29,31,32,34,36 used the PI-RADS score to interpret the images (PI-RADS v2, n = 8; PI-RADS v2.1, n = 1).…”

Section: Studies On Mri For Predicting Prostate Biopsy Resultsmentioning

confidence: 99%

“…Five studies 16,23,30,33,39 used 1 H MRS sequences in combination with other conventional sequences and 1 study 22 used only T2WI. With regard to MRI image interpretation, 12 studies 21,[24][25][26]28,29,31,32,34,[36][37][38] used the Prostate Imaging Reporting and Data System (PI-RADS) score. Out of these 12 studies, 10 used the PI-RADS v2 and 2 studies 31,37 used the PI-RADS v2.1.…”

Section: Mr Characteristicsmentioning

confidence: 99%

“…The samples in 15 studies 19,[21][22][23][24][25][26][27][28][29][30][31][32][33]35 consisted exclusively of patients with PSA between 4 ng/mL and 10 ng/mL, while a group of patients with PSA levels within the gray zone was only one of the several groups of study samples in seven studies. 17,20,34,[36][37][38][39] With regard to study objectives, 6 of the 23 (26.1%) studies 19,21,30,[37][38][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][25][26]31,[33][34][35]37,38 or high-grade PCa (HGPCa) 29,32 by MRI or MRS, which showed large heterogeneity across studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Chen

2022

Magnetic Resonance Imaging

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Improving the detection rates of prostate cancer (PCa) and avoiding unnecessary prostate biopsies in men with prostate‐specific antigen (PSA) levels within the gray zone require urgent attention. In this context, rapid advances in MR technology in recent years may offer a promising possibility. A systematic review to evaluate the applications of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in detecting PCa and clinically significant PCa (csPCa) in men with PSA levels within the gray zone. The study type is defined as systematic review. In July 2022, out of 229 studies identified by the database search and from other sources, 23 articles related to the selected topic of interest were included in this review. No field strength or sequence restrictions. The data including the study population, study characteristics, as well as basic MRI characteristics, from the final studies included in this review, were extracted independently by two reviewers. The major results of the original study were summarized and no additional statistical analysis was performed. Among the 23 studies included in this review, 17 focused on the applications of MRS and MRI for the prebiopsy diagnosis of PCa. Nine of these 17 articles used Prostate Imaging Reporting and Data System (PI‐RADS) score to interpret MRI results, thereby confirming the practicality of the PI‐RADS score in predicting PCa and csPCa. The remaining six articles evaluated the applications of MRI and MRS in guiding prostate biopsy. Although there was a variation in the biopsy modalities used in these studies, both MRI‐ and MRS‐guided prostate biopsies were observed to improve the detection rates of PCa and csPCa in patients with PSA levels within the gray zone. MRS and MRI showed good performance in the detection of PCa and csPCa before biopsy. In addition, MRS‐ or MRI‐guided prostate‐targeted biopsies were able to improve the detection rates of PCa and csPCa. Evidence Level 3 Technical Efficacy Stage 2

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“…PI-RADS v2.0 using mpMRI, which has a superior image quality than TRUS, is used to diagnose prostate cancer. However, Lu et al [23] reported that MRI ndings with a PI-RADS score of 3 or higher in patients with gray zone PSA level were at 38.2%, and the authors suggested using total PSA, PSAD, and PSA-age volume adjustments to improve the detection rate of prostate cancer in these patients.…”

Section: Discussionmentioning

confidence: 99%

Is PSA Density of the Peripheral Zone as a Useful Predictor for Prostate Cancer in Patients With Gray Zone PSA Levels?

Lee

Yang

Jin

et al. 2020

Preprint

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BackgroundSerum prostate-specific antigen (PSA) is widely used in screening tests for prostate cancer. As the low specificity of PSA results in unnecessary and invasive prostate biopsies, we evaluated the clinical significance of various PSAs and PSA density (PSAD) related to peripheral zones in patients with gray zone PSA level (4-10 ng/mL).MethodsA total of 1,300 patients underwent transrectal ultrasonography-guided prostate biopsy from 2014 to 2019. Among them, 545 patients in the gray zone were divided into the prostate cancer diagnosis group and the non-prostate cancer diagnosis group, and PSA, relative extra transitional zone PSA (RETzPSA), estimated post holmium laser enucleation of the prostate PSA (EPHPSA), PSAD, peripheral zone PSA density (PZPSAD) and extra-transitional zone density (ETzD) were compared and analyzed using receiver-operating characteristics (ROC) analysis after 1:1 matching using propensity score.ResultsArea under the ROC curve values of PSA, EPHPSA, RETzPSA, PSA density, ETzD, and PZPSAD were 0.553 (95% CI: 0.495-0.610), 0.611 (95% CI: 0.554-0.666), 0.673 (95% CI: 0.617-0.725), 0.745 (95% CI: 0.693-0.793), 0.731 (95% CI: 0.677-0.780) and 0.677 (95% CI: 0.611-0.719), respectively. PSAD had 67.11% sensitivity, 71.71% specificity, and 70.34% positive predictive rate at 0.18 ng/mL/cc. ETzD had 69.08% sensitivity, 64.47% specificity, and 66.04% positive predictive rate at 0.04 ng/mL/cc. When the cut-off value of PSAD was increased to 0.18 ng/mL/cc, the best results were obtained with an odds ratio of 5.171 (95% CI: 3.171-8.432), followed by ETzD with 4.054 (95% CI: 2.513-6.540).ConclusionsThese results suggested that volume-adjusted parameters (ETzD and PSAD) might be more sensitive and accurate than various PSA in gray zone patients who required prostate biopsy to reduce unnecessary biopsy.

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Improving the detection rate of prostate cancer in the gray zone of PI-RADS v2 and serum tPSA by using prostate-specific antigen–age volume

Cited by 7 publications

References 29 publications

Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

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

Is PSA Density of the Peripheral Zone as a Useful Predictor for Prostate Cancer in Patients With Gray Zone PSA Levels?

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