Diagnostic value comparison of the combination of prostate-specific membrane antigen-body PET/MR and the prostate health index with each alone in early diagnosis of prostate cancer

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY Asian Journal of Urology Pub Date : 2024-10-01 DOI:10.1016/j.ajur.2023.10.003

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Abstract

Objective

This study aimed to figure out whether the combination of the prostate health index (PHI) and prostate-specific membrane antigen (PSMA)-PET/MR could improve the diagnostic accuracy for prostate cancer (PCa) than that of each individual method used alone.

Methods

In this prospective, observational study, 41 patients who underwent the systematic prostate biopsy between June 2019 and September 2022 were enrolled. Both the PHI test and ¹⁸F-PSMA-1007-PET/MR were performed prior to biopsies. The diagnostic accuracy of different models was compared by logistic regression, areas under the curve (AUCs) of the receiver operating characteristic, and net reclassification index (NRI).

Results

Among the 41 patients, 14 (34.1%) were pathologically diagnosed with PCa. The PHI in the PCa group was significantly higher than that in the benign group (44.4 vs. 35.0, p=0.048). Similarly, all the patients in the PCa group received positive results of ¹⁸F-PSMA-1007-PET/MR, of which the positive rate was significantly higher than that in benign group (100% vs. 62.96%, p=0.025). The ¹⁸F-PSMA-1007-PET/MR provided additional diagnostic values to the PHI (AUC: 0.802 vs. 0.692, p=0.025). However, there was no significant difference between the combination model and the ¹⁸F-PSMA-1007-PET/MR alone (AUC 0.802 vs. 0.685, p=0.071). The optimal PHI cutoff of the combination model is 32, with which the model could significantly reduce unnecessary biopsies (NRI: 22.22%, 95% confidence interval: 6.54%–37.90%, p=0.005). However, among patients with the PHI of ≥43.5, there was no significant difference between the combination model and the PHI alone (NRI: 11.11%, 95% confidence interval: −0.74%–22.97%, p=0.066).

Conclusion

The combination of the PHI and ¹⁸F-PSMA-1007-PET/MR outperforms the PHI alone for predicting PCa, especially in avoiding unnecessary biopsies. However, for patients with the PHI of ≥43.5, the addition of ¹⁸F-PSMA-1007-PET/MR to the PHI does not yield additional benefits.

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前列腺特异性膜抗原-体层正电子发射断层扫描/磁共振成像和前列腺健康指数的组合与各自单独使用在前列腺癌早期诊断中的诊断价值比较

目的本研究旨在探讨前列腺健康指数（PHI）和前列腺特异性膜抗原（PSMA）-PET/MR联合使用是否能比单独使用每种方法提高前列腺癌（PCa）的诊断准确性。方法在这项前瞻性观察研究中，共纳入了41名在2019年6月至2022年9月期间接受系统性前列腺活检的患者。活检前进行 PHI 检测和 18F-PSMA-1007-PET/MR 检测。通过逻辑回归、接收者操作特征曲线下面积（AUC）和净再分类指数（NRI）比较了不同模型的诊断准确性。PCa 组的 PHI 明显高于良性组（44.4 对 35.0，P=0.048）。同样，PCa 组所有患者的 18F-PSMA-1007-PET/MR 结果均为阳性，其中阳性率明显高于良性组（100% 对 62.96%，P=0.025）。18F-PSMA-1007-PET/MR为PHI提供了额外的诊断价值（AUC：0.802 vs. 0.692，p=0.025）。然而，组合模型与单独使用 18F-PSMA-1007-PET/MR 没有明显差异（AUC 0.802 vs. 0.685，p=0.071）。联合模型的最佳 PHI 临界值为 32，该模型可显著减少不必要的活检（NRI：22.22%，95% 置信区间：6.54%-37.90%，P=0.005）。结论 PHI 和 18F-PSMA-1007-PET/MR 的组合在预测 PCa 方面优于单用 PHI，尤其是在避免不必要的活检方面。然而，对于 PHI≥43.5 的患者，在 PHI 的基础上增加 18F-PSMA-1007-PET/MR 并不能带来额外的益处。

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来源期刊

Asian Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

4.00

自引率

3.80%

发文量

100

审稿时长

4 weeks

期刊介绍： Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.