Assessing the Impact of Transition and Peripheral Zone PSA Densities Over Whole-Gland PSA Density for Prostate Cancer Detection on Multiparametric MRI.

IF 2.5 3区医学 Q3 ENDOCRINOLOGY & METABOLISM Prostate Pub Date : 2025-05-01 Epub Date: 2025-02-25 DOI:10.1002/pros.24863

Omer Tarik Esengur, Emma Stevenson, Hunter Stecko, Nathan S Lay, Dong Yang, Jesse Tetreault, Ziyue Xu, Daguang Xu, Enis C Yilmaz, David G Gelikman, Stephanie A Harmon, Maria J Merino, Sandeep Gurram, Bradford J Wood, Peter L Choyke, Peter A Pinto, Baris Turkbey

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Abstract

Background: Whole-gland (WG) prostate-specific antigen (PSA) density (PSAD) has proven useful in diagnosing to be beneficial in localized prostate cancer (PCa). This study aimed to evaluate the predictive performance of WG and zonal (transition zone [TZ] and peripheral zone [PZ]) PSAD in predicting PCa and clinically significant PCa (csPCa) in prostate MRI.

Methods: A retrospective analysis was conducted on consecutive patients who underwent multiparametric MRI and MRI/US fusion-guided biopsy between March 2019 and July 2024. TZ-PSAD, PZ-PSAD, and WG-PSAD were calculated using in-house AI models. Optimal thresholds for TZ-PSAD and PZ-PSAD were determined using the Youden index from receiver operating characteristic (ROC) curve analyses with five-fold cross-validation, whereas 0.15 ng/mL² was applied as the threshold for WG-PSAD. Statistical comparisons were performed using Wilcoxon rank-sum, χ², and Fisher's exact tests. Logistic regression (LR) and area under the ROC curve (AUC) analyses with DeLong's test were conducted to evaluate diagnostic performance.

Results: The study cohort included 774 consecutive patients (median age = 67 years [interquartile range {IQR}: 61-71], median WG-PSAD = 0.11 ng/mL² [IQR: 0.07-0.17], median TZ-PSAD = 0.22 ng/mL² [IQR: 0.12-0.41], median PZ-PSAD = 0.13 ng/mL² [IQR: 0.16-0.34]). Among these patients, 475 had PCa and 341 had csPCa. The mean optimal thresholds for TZ-PSAD and PZ-PSAD were 0.20 ng/mL² and 0.21 ng/mL², respectively, for PCa, whereas they were 0.26 and 0.23, respectively, for csPCa. Multivariable LR identified TZ-PSAD (OR = 2.00, p = 0.03) and WG-PSAD (OR = 2.40, p = 0.02) as significant predictors of PCa. For csPCa, TZ-PSAD was the only independent predictor (OR = 2.13, p = 0.02) among PSAD measurements. TZ-PSAD showed a superior AUC for both PCa (0.79 ± 0.05) and csPCa (0.77 ± 0.02) compared to WG-PSAD (0.77 ± 0.06 for PCa, 0.76 ± 0.03 for csPCa) and PZ-PSAD (0.69 ± 0.06 for PCa, 0.70 ± 0.04 for csPCa; p < 0.001).

Conclusions: Both TZ-PSAD and WG-PSAD are strong predictors of PCa, but TZ-PSAD is a superior predictor of csPCa compared to WG-PSAD and PZ-PSAD. Further prospective studies are warranted to validate these findings.

Trial registration: NCT03354416.

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在多参数MRI上评估过渡区和外围区PSA密度对全腺体PSA密度对前列腺癌检测的影响。

背景：全腺体（WG）前列腺特异性抗原（PSA）密度（PSAD）已被证明有助于诊断局限性前列腺癌（PCa）。本研究旨在评估WG和分区（过渡区[TZ]和外周区[PZ]） PSAD在前列腺MRI中预测前列腺癌和临床显著性前列腺癌（csPCa）的预测能力。方法：对2019年3月至2024年7月连续接受多参数MRI和MRI/US融合引导活检的患者进行回顾性分析。z - psad、PZ-PSAD和WG-PSAD采用内部人工智能模型计算。采用受试者工作特征（ROC）曲线分析的约登指数确定z - psad和PZ-PSAD的最佳阈值，采用0.15 ng/mL2作为WG-PSAD的阈值。采用Wilcoxon秩和、χ2和Fisher精确检验进行统计学比较。采用DeLong检验进行Logistic回归（LR）和ROC曲线下面积（AUC）分析，评价诊断效果。结果：研究队列纳入774例连续患者（中位年龄= 67岁[四分位数间距{IQR}: 61-71]，中位WG-PSAD = 0.11 ng/mL2 [IQR: 0.07-0.17]，中位z - psad = 0.22 ng/mL2 [IQR: 0.12-0.41]，中位PZ-PSAD = 0.13 ng/mL2 [IQR: 0.16-0.34]）。其中475例为PCa， 341例为csPCa。对于PCa， z - psad和PZ-PSAD的平均最佳阈值分别为0.20 ng/mL2和0.21 ng/mL2，而对于csPCa，它们分别为0.26和0.23 ng/mL2。多变量LR发现TZ-PSAD （OR = 2.00, p = 0.03）和WG-PSAD （OR = 2.40, p = 0.02）是PCa的显著预测因子。对于csPCa， z -PSAD是PSAD测量中唯一的独立预测因子（OR = 2.13, p = 0.02）。与WG-PSAD （PCa为0.77±0.06，csPCa为0.76±0.03）和PZ-PSAD （PCa为0.69±0.06，csPCa为0.70±0.04）相比，TZ-PSAD对PCa（0.79±0.05）和csPCa（0.77±0.04）的AUC均优于WG-PSAD (PCa为0.79±0.05)；p结论：TZ-PSAD和WG-PSAD都是PCa的强预测因子，但TZ-PSAD比WG-PSAD和PZ-PSAD更能预测csPCa。需要进一步的前瞻性研究来验证这些发现。试验注册：NCT03354416。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate 医学-泌尿学与肾脏学

CiteScore

5.10

自引率

3.60%

发文量

180

审稿时长

1.5 months

期刊介绍： The Prostate is a peer-reviewed journal dedicated to original studies of this organ and the male accessory glands. It serves as an international medium for these studies, presenting comprehensive coverage of clinical, anatomic, embryologic, physiologic, endocrinologic, and biochemical studies.