Predictors of Prostate Cancer Evaluated by Receiver Operating Characteristics Partial Area Index: A Prospective Institutional Study

Gjengstø, Peder; Paus, Elisabeth; Halvorsen, Ole J.; Eide, Johan; Akslen, Lars A.; Wentzel‐Larsen, Tore; Høisæter, Per Å.

doi:10.1097/01.ju.0000149805.83040.1f

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…In cancer screening, high sensitivity is necessary to reduce the risk of missing cancers. Sensitivity of at least 90% is needed 6 . Morphological evaluation by means of MR imaging for the detection of PCa does not include identification of biochemical factors that alert screeners to the possibility of PCa.…”

Section: Introductionmentioning

confidence: 99%

“…Sensitivity of at least 90% is needed. 6 Morphological evaluation by means of MR imaging for the detection of PCa does not include identification of biochemical factors that alert screeners to the possibility of PCa. Thus, we hypothesized that combined analysis of the morphological (MR imaging findings) and biochemical (PSAD) factors would enhance both sensitivity and specificity for the early detection of PCa.…”

Section: Introductionmentioning

confidence: 99%

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The potential role of prebiopsy magnetic resonance imaging combined with prostate‐specific antigen density in the detection of prostate cancer

Kubota

Kamei²,

Nakano³

et al. 2008

Int J of Urology

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Aim: Two-thirds of patients with a gray-zone prostate-specific antigen (PSA) level undergo unnecessary biopsy. Sensitivity is not yet sufficient to permit the use of modified PSA parameters or magnetic resonance (MR) imaging alone for prostate cancer screening. Thus, we evaluated the combination of MR imaging and PSA density (PSAD) for specificity and sensitivity. Methods: During the period April 2004 through March 2006, 185 patients with a PSA level of 4.0-10.0 ng/mL underwent MR imaging and transrectal ultrasonography-guided 8-core biopsy (systemic sextant biopsy of the peripheral zone plus two cores of transition zone). All MR images were interpreted prospectively by two radiologists. An image was considered positive for prostate cancer if any feature indicated a cancerous lesion. Receiver operating characteristic (ROC) curves were used to compare the usefulness of the PSA level, PSAD and PSA transitional zone density (PSATZ) for the detection of prostate cancer. Results: Of the 185 patients, 62 had prostate cancer. Sensitivity and specificity of the axial T2-weighted MR imaging findings for cancer detection were 79.0% and 59.4%, respectively. The area under the ROC curve was 0.590 for the PSA level, 0.718 for PSAD and 0.695 for PSATZ. MR imaging findings and PSAD were shown by multivariate analysis to be statistically significant independent predictors of prostate cancer (P < 0.001). With a PSAD cut-off value of 0.111, sensitivity was 96.8%, but specificity was 19.5%. Combining MR imaging findings with PSAD increased the specificity to 40% and retained 95% sensitivity. Conclusion: MR imaging findings combined with PSAD provide high sensitivity and improve the specificity for the early detection of prostate cancer.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The potential role of prebiopsy magnetic resonance imaging combined with prostate‐specific antigen density in the detection of prostate cancer

Kubota

Kamei²,

Nakano³

et al. 2008

Int J of Urology

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“…In order to check the clinical utility of [−7/−5]proPSA, head‐to‐head comparison with all commercially available PSA‐related parameters was conducted. To assess the discriminating power of PSA‐related markers, investigating specificity around the high sensitivity range could be more important in clinical settings. In the present study, not only the full‐range area under the curve of receiver operating characteristics (AUC‐ROC), 11 but also the partial AUC‐ROC (pAUC‐ROC) 12 was estimated. Investigating the pAUC‐ROC, which is a high‐sensitivity part of AUC‐ROC, may be more reasonable for evaluating the clinical significance of various tumor markers than doing traditional AUC‐ROC. In order to assess the independent discriminating power of PSA‐related markers, multiple logistic regression analyses were also carried out for selected clinical parameters.…”

Section: Introductionmentioning

confidence: 99%

“…To assess the discriminating power of PSA‐related markers, investigating specificity around the high sensitivity range could be more important in clinical settings. In the present study, not only the full‐range area under the curve of receiver operating characteristics (AUC‐ROC), 11 but also the partial AUC‐ROC (pAUC‐ROC) 12 was estimated. Investigating the pAUC‐ROC, which is a high‐sensitivity part of AUC‐ROC, may be more reasonable for evaluating the clinical significance of various tumor markers than doing traditional AUC‐ROC.…”

Section: Introductionmentioning

confidence: 99%

Proprostate‐specific antigen: Its usefulness in the era of multiple‐core prostate biopsy

et al. 2009

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Objective: To investigate the clinical significance of prostate-specific antigen (PSA)-related markers, including the precursor form of PSA, using the full-range area under the curve of receiver operating characteristics (AUC-ROC), partial AUC-ROC (pAUC-ROC) and multiple logistic regression analyses. Methods: Participants consisted of 257 consecutive men (PSA range 4.1-20 ng/mL) undergoing transrectal ultrasonography-guided ageadjusted and prostate volume-adjusted multiple-core prostate biopsy at Gunma University Hospital between January 2003 and May 2005. Sensitivity, specificity, AUC-ROC and pAUC-ROC of the ratio of free PSA to total PSA (free/total PSA), PSA density (PSAD) and PSAD adjusted by transition zone volume, the ratio of [-7/-5] precursor forms of PSA (proPSA) to free PSA (pro/free PSA), the ratio of pro to total PSA and the ratio of pro to free/total PSA (pro/f/t ratio) were investigated. Multiple logistic regression analyses were also carried out to investigate the independency of selected clinical parameters. Results: According to pAUC-ROC analyses, pro/free PSA and the pro/f/t ratio were the two best PSA-related parameters in terms of maintaining high sensitivity and avoiding unnecessary biopsy. Multiple regression analyses revealed that not only pro/free PSA, but also age, findings on digital rectal examination and PSAD were independent parameters for predicting biopsy outcomes. Conclusion: Pro/free PSA and pro/f/t ratio may be excellent predictive markers for prostate cancer, allowing unnecessary biopsy to be avoided while maintaining high sensitivity at 90% or 95%, in the PSA range 4-20 ng/mL.

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“…Thus, such ROC curves may differ in clinically relevant ways (34 ). Alternatively, partial areas of ROC curves may be used to assess the diagnostic value (36 ).…”

Section: Discriminationmentioning

confidence: 99%

Avoiding Pitfalls in Applying Prediction Models, As Illustrated by the Example of Prostate Cancer Diagnosis

et al. 2011

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BACKGROUND:The use of different mathematical models to support medical decisions is accompanied by increasing uncertainties when they are applied in practice. Using prostate cancer (PCa) risk models as an example, we recommend requirements for model development and draw attention to possible pitfalls so as to avoid the uncritical use of these models. CONTENT:We conducted MEDLINE searches for applications of multivariate models supporting the prediction of PCa risk. We critically reviewed the methodological aspects of model development and the biological and analytical variability of the parameters used for model development. In addition, we reviewed the role of prostate biopsy as the gold standard for confirming diagnoses. In addition, we analyzed different methods of model evaluation with respect to their application to different populations. When using models in clinical practice, one must validate the results with a population from the application field. Typical model characteristics (such as discrimination performance and calibration) and methods for assessing the risk of a decision should be used when evaluating a model's output. The choice of a model should be based on these results and on the practicality of its use.

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Predictors of Prostate Cancer Evaluated by Receiver Operating Characteristics Partial Area Index: A Prospective Institutional Study

Cited by 12 publications

References 15 publications

The potential role of prebiopsy magnetic resonance imaging combined with prostate‐specific antigen density in the detection of prostate cancer

The potential role of prebiopsy magnetic resonance imaging combined with prostate‐specific antigen density in the detection of prostate cancer

Proprostate‐specific antigen: Its usefulness in the era of multiple‐core prostate biopsy

Avoiding Pitfalls in Applying Prediction Models, As Illustrated by the Example of Prostate Cancer Diagnosis

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