[The value of DISCO and MUSE-DWI combined with prostate specific antigen density in the diagnosis and risk stratification of prostate cancer].
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Objective: To explore the value of differential subsampling with cartesian ordering (DISCO) and multiplexed sensitivity-encoding diffusion weighted-imaging (MUSE-DWI) combined with prostate specific antigen density (PSAD) in the diagnosis and risk stratification of prostate cancer (PCa). Methods: The data of 183 patients [aged from 48 to 86 (68±8) years] with prostate diseases in the General Hospital of Ningxia Medical University from July 2020 to August 2021 were retrospectively collected. Those patients were divided into non-PCa group (n=115) and PCa group (n=68) based on the disease condition. According to the risk degree, PCa group was subdivided into low risk PCa group (n=14) and medium-to-high risk PCa group (n=54). The differences of volume transfer constant (Ktrans), rate constant (Kep), extracellular volume fraction (Ve), apparent diffusion coefficient (ADC) and PSAD between groups were analyzed. Receiver operating characteristic (ROC) curves analysis were conducted for evaluating the diagnostic efficacy of quantitative parameters and PSAD in distinguishing non-PCa and PCa, low-risk PCa and medium-high risk PCa. Multivariate logistic regression model was used for screening out the predictors, which was statistically significant differences between non-PCa group and PCa group, for PCa prediction. Results: Ktrans, Kep, Ve and PSAD of PCa group all were higher than those of non-PCa group, and ADC value was lower than that of non-PCa group, and the differences all were statistically significant (all P<0.001). Ktrans, Kep and PSAD of medium-to-high risk PCa group all were higher than those of low risk PCa group, and ADC value was lower than that of low risk PCa group, and the differences were all statistically significant (all P<0.001). When distinguishing non-PCa from PCa, the area under ROC curve (AUC) of the combined model (Ktrans+Kep+Ve+ADC+PSAD) was higher than that of any single index [0.958 (95%CI: 0.918-0.982) vs 0.881 (95%CI: 0.825-0.924), 0.836 (95%CI: 0.775-0.887), 0.672 (95%CI: 0.599-0.740), 0.940(95%CI: 0.895-0.969), 0.816(95%CI:0.752-0.869), all P<0.05]. When distinguishing low-risk PCa and medium-to-high risk PCa, the AUC of the combined model (Ktrans+Kep+ADC+PSAD) were higher than those of Ktrans, Kep and PSAD[0.933 (95%CI: 0.845-0.979) vs 0.846 (95%CI:0.738-0.922), 0.782 (95%CI:0.665-0.873), 0.84 8(95%CI: 0.740-0.923), all P<0.05]. The multivariate logistic regression analysis showed that Ktrans (OR=1.005, 95%CI:1.001-1.010) and ADC values (OR=0.992, 95%CI:0.989-0.995) were predictors of PCa (P<0.05). Conclusions: DISCO and MUSE-DWI combined with PSAD can distinguish benign and malignant prostate lesions. Ktrans and ADC values were predictors of PCa; Ktrans, Kep, ADC values and PSAD are helpful in predicting the biological behavior of PCa.目的： 探究基于笛卡尔采集的K空间共享三维容积快速动态成像（DISCO）和复合灵敏度编码的高分辨率扩散成像（MUSE-DWI）联合前列腺特异性抗原密度（PSAD）在前列腺癌（PCa）的诊断及危险分层中的价值。 方法： 回顾性收集2020年7月至2021年8月宁夏医科大学总医院183例［年龄：48~86（68±8）岁］前列腺疾病患者的资料。根据疾病情况分为非PCa组115例，PCa组68例，其中PCa组又根据危险程度分为低危PCa组14例，中高危PCa组54例。分析组间容积转移常数（Ktrans）、速率常数（Kep）、血管外细胞外体积分数（Ve）、表观扩散系数（ADC）和PSAD的差异。采用受试者工作特征（ROC）曲线评估各定量参数值及PSAD鉴别非PCa和PCa、低危PCa和中高危PCa的诊断效能。采用多因素logistic回归模型对非PCa组和PCa组间差异有统计学意义的指标进行分析，筛选出PCa的预测因子。 结果： PCa组的Ktrans、Kep、Ve值和PSAD均高于非PCa组，ADC值低于非PCa组，差异均有统计学意义（均P<0.001）；中高危PCa组的Ktrans、Kep值和PSAD均高于低危PCa组，ADC值低于低危PCa组，差异均有统计学意义（均P<0.001）。鉴别非PCa和PCa时，联合模型（Ktrans+Kep+Ve+ADC+PSAD）的ROC曲线下面积（AUC）高于单一指标［0.958（95%CI：0.918~0.982）比0.881（95%CI：0.825~0.924）、0.836（95%CI：0.775~0.887）、0.672（95%CI：0.599~0.740）、0.940（95%CI：0.895~0.969）、0.816（95%CI：0.752~0.869），均P<0.05］；鉴别低危PCa和中高危PCa时，联合模型（Ktrans+Kep+ADC+PSAD）的AUC高于Ktrans、Kep和PSAD［0.933（95%CI：0.845~0.979）比0.846（95%CI：0.738~0.922）、0.782（95%CI：0.665~0.873）、0.848（95%CI：0.740~0.923），均P<0.05］。多因素logistic回归分析显示Ktrans（OR=1.005，95%CI：1.001~1.010）和ADC值（OR=0.992，95%CI：0.989~0.995）是PCa的预测因子（P<0.05）。 结论： DISCO和MUSE-DWI联合PSAD可以鉴别前列腺良恶性病变，Ktrans和ADC值是PCa的预测因子；Ktrans、Kep、ADC值和PSAD有助于预测PCa的生物学行为。.Keywords:
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You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2014MP63-17 EARLY DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER: LOW FREE PROSTATE-SPECIFIC ANTIGEN LEVELS AS A CRITERION FOR PROSTATE BIOPSY IN PATIENTS WITH LOW TOTAL PROSTATE-SPECIFIC ANTIGEN LEVELS Mitsuharu Sasaki, Shigeto Ishidoya, Akihiro Ito, Kenji Numahata, Daisuke Shibuya, and Yoichi Arai Mitsuharu SasakiMitsuharu Sasaki More articles by this author , Shigeto IshidoyaShigeto Ishidoya More articles by this author , Akihiro ItoAkihiro Ito More articles by this author , Kenji NumahataKenji Numahata More articles by this author , Daisuke ShibuyaDaisuke Shibuya More articles by this author , and Yoichi AraiYoichi Arai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1954AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The present study investigated whether applying %fPSA as a criterion for prostate biopsy in patients with low PSA (≤ 4.0 ng/mL) could facilitate early diagnosis of clinically significant prostate cancer. METHODS Free prostate-specific antigen (fPSA) levels have been measured in addition to total prostate-specific antigen (PSA) in all patients undergoing prostate cancer screening at Tohoku University and the Miyagi Cancer Society since July 2001. Subjects comprised 9,522 patients who underwent screening for prostate cancer between July 2001 and June 2011. Patients with %fPSA ≤ 12% and PSA 2.0 - 10.0 ng/mL with no gaps in prostate biopsy histopathological diagnosis (n = 260) were divided into the following two PSA groups: low (PSA: 2.0 - 4.0 ng/mL) and mildly elevated (PSA: 4.1 - 10.0 ng/mL). Malignancy was evaluated based on Gleason scores of biopsy specimens. Statistical significance was assessed using Pearsons χ2 test. RESULTS Median age, PSA, and %fPSA were 66 years, 4.5 ng/mL, and 9.9%, respectively. A total of 129 patients (49.6%) were diagnosed with prostate cancer based on biopsy of all patients in the low PSA (n = 114, 43.8%) and mildly elevated PSA (n = 146, 56.2%) groups. No significant differences were observed between the low PSA group and the mildly elevated PSA group (p = 0.1010) in prostate cancer detection rate. Patients were then further classified as low, medium, or high risk (Gleason scores ≤ 6, 7 and 8 ≤, respectively) based on biopsy histopathological diagnosis. However, no significant differences were observed between the low and mildly elevated PSA groups (p=0.9974) in malignancy. Overall detection rate in the medium- and high-risk patients was 76%, and highly¡¡malignant prostate cancer was efficiently detected. CONCLUSIONS If %fPSA is low, clinically significant prostate cancer is likely to be diagnosed, even in patients with low total PSA. A high detection rate of 76% was achieved in medium- and high-risk patients, demonstrating that highly malignant prostate cancer was efficiently detected. Including %fPSA as a criterion for prostate biopsy could facilitate early diagnosis of clinically significant prostate cancer, even in patients with low total PSA. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e715 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mitsuharu Sasaki More articles by this author Shigeto Ishidoya More articles by this author Akihiro Ito More articles by this author Kenji Numahata More articles by this author Daisuke Shibuya More articles by this author Yoichi Arai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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Objective:To evaluate the diagnostic power of prostate-specific G-protein coupled receptor(PSGR)score in urine sediments to detect prostate cancer in initial prostate biopsy.Method:Urine was collected after digital rectal examination(DRE)from 299 men before prostate biopsy.The specimens were collected from January 2010 to October 2013.The expression of PSGR mRNA and mRNA were determined by quantitative real time polymerase chain reaction(qRT-PCR).PSGR scores were calculated by PSGR mRNA/PSA mRNA×1 000.The ability of PSGR score to predict the biopsy outcome was assessed with an AUC-ROC analysis and compared with the serum levels.Result:The informative specimen rate was 81.94%(245/299).The rates of positive prostate biopsy in overall patients and PSA grey zone patients were 33.46%(83/245)and 27.05%(33/122).PSGR scores were significantly higher in patients with positive biopsy compared with patients of negative biopsy results(P0.001).In the group of overall patients,ROC curve analysis demonstrated that the area under ROC curve(AUC)of serum total PSA(tPSA),PSGR score and the duplex model combining tPSA and PSGR score was 0.584,0.687 and 0.713,respectively.The duplex model represented a better approach to diagnosing PCa than tPSA alone in prostate biopsy(P=0.002),but there is no statistical significance between tPSA and PSGR score(P=0.052).Further analysis of the diagnostic performance of PSGR score in the subgroup with PSA=4-10μg/L revealed that the area under ROC curve(AUC)of tPSA,PSGR score and the duplex model was 0.525,0.727and0.731,respectively.PSGR score was much better than tPSA alone to diagnose PCa in PSA grey zone subgroup(P=0.004).Conclusion:PSGR is found to be a good predictor of prostate cancer in the initial prostate biopsy.The duplex model combining tPSA and PSGR score can improve the diagnostic potency in overall group and PSGR score alone can be a good predictor in the subgroup with PSA=4-10μg/L.
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We examined the effect of 5α-reductase inhibitor therapy on prostate cancer detection in men with persistently increased or fluctuating prostate specific antigen and prior negative prostate cancer biopsy.A total of 276 men with prostate specific antigen greater than 4 ng/ml (208) or a prostate specific antigen velocity change of 0.75 ng/ml (68) and a normal digital rectal examination who had previously undergone biopsy a minimum of 2 times with prostate cancer not detected were given 5 mg finasteride (154) or dutasteride (122) daily. In phase 1, 97 patients had prostate specific antigen measured at 6 and 12 months with repeat transrectal ultrasonography and biopsy (12 cores) performed at 1 year. In phase 2, 179 patients underwent biopsy triggered by a change in nadir prostate specific antigen of more than 0.4 ng/ml.In phase 1 at 1 year prostate specific antigen had decreased by 2.4 ng/ml (-46.7%), and prostate volume had decreased 7.1 ml (-17.9%). Prostate cancer was detected in 27 of 97 (27.8%) patients and the mean minimum prostate specific antigen velocity from a nadir of 0.4 ng/ml was 0.6 ng/ml. In phase 2, 48 of 179 (26.8%) men underwent repeat biopsy at a mean of 14.6 months. Of these 48 men 26 (54.1%) were found to have prostate cancer. Of the 26 men in whom prostate cancer was detected 20 (76.9%) were found to have Gleason score 7 or greater disease.The magnitude of change in serum prostate specific antigen after 5α-reductase inhibitor therapy may be useful in diagnosing prostate cancer in patients with persistently increased or fluctuating prostate specific antigen and prior negative prostate biopsy.
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We aimed to determine whether the effect of prostate volume on cancer detection rates is influenced by serum prostate-specific antigen (PSA).A total of 2465 men who underwent transrectal ultrasound-guided biopsy were retrospectively evaluated. Standard 10-core prostate biopsy was performed in all cases. Patients were divided into three groups according to the serum PSA levels: ≤10 ng/mL (Group 1), 10-20 ng/mL (Group 2) and >20 ng/mL (Group 3). In each group age, serum PSA levels and prostate volumes were compared in patients with and without prostate cancer.A total of 2079 patients were included in the study group. Cancer detection rates were 16%, 25%, 53% in Groups 1, 2 and 3, respectively (p=0.001). In Group 1, there was a significant difference in mean prostate volume of patients with and without prostate cancer (p=0.01). However, this difference was not seen in Group 2 or 3 (p=0.06 and p=0.08, respectively). The mean age and PSA level which are the other determinants of prostate cancer diagnosis were similar between patients with and without cancer in the Group 1, thus prostate volume was the only determinant of the diagnosis.According to our findings, prostate volume is an important factor for prostate cancer diagnosed with prostate biopsy only in patients with a PSA level of ≤10 ng/mL.
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The risk of prostate cancer (PCa) in prostate imaging reporting and data system version 2 (PI-RADSv2) score-3 lesions is equivocal; it is regarded as an intermediate status of presented PCa. In this study, we evaluated the clinical utility of the prostate health index (PHI) for the diagnosis of PCa and clinically significant PCa (csPCa) in patients with PI-RADSv2 score-3 lesions. The study cohort included patients who underwent a transrectal ultrasound (TRUS)-guided, cognitive-targeted biopsy for PI-RADSv2 score-3 lesions between November 2018 and April 2021. Before prostate biopsy, the prostate-specific antigen (PSA) derivatives, such as total PSA (tPSA), [-2] proPSA (p2PSA) and free PSA (fPSA) were determined. The calculation equation of PHI is as follows: [(p2PSA/fPSA) × tPSA ½]. Using a receiver operating characteristic (ROC) curve analysis, the values of PSA derivatives measured by the area under the ROC curve (AUC) were compared. For this study, csPCa was defined as Gleason grade 2 or higher. Of the 392 patients with PI-RADSv2 score-3 lesions, PCa was confirmed in 121 (30.9%) patients, including 59 (15.1%) confirmed to have csPCa. Of all the PSA derivatives, PHI and PSA density (PSAD) showed better performance in predicting overall PCa and csPCa, compared with PSA (all p < 0.05). The AUC of the PHI for predicting overall PCa and csPCa were 0.807 (95% confidence interval (CI): 0.710−0.906, p = 0.001) and 0.819 (95% CI: 0.723−0.922, p < 0.001), respectively. By the threshold of 30, PHI was 91.7% sensitive and 46.1% specific for overall PCa, and was 100% sensitive for csPCa. Using 30 as a threshold for PHI, 34.4% of unnecessary biopsies could have been avoided, at the cost of 8.3% of overall PCa, but would include all csPCa.
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No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2003Prostatic Zinc and Prostate Specific Antigen: An Experimental Evaluation of Their Combined Diagnostic Valueis corrected byRE: PROSTATIC ZINC AND PROSTATE SPECIFIC ANTIGEN: AN EXPERIMENTAL EVALUATION OF THEIR COMBINED DIAGNOSTIC VALUE D. VARTSKY, S. SHILSTEIN, A. BERCOVICH, M. HUSZAR, A. BRESKIN, R. CHECHIK, S. KOROTINSKY, S.D. MALNICK, and E. MORIEL D. VARTSKYD. VARTSKY , S. SHILSTEINS. SHILSTEIN , A. BERCOVICHA. BERCOVICH , M. HUSZARM. HUSZAR , A. BRESKINA. BRESKIN , R. CHECHIKR. CHECHIK , S. KOROTINSKYS. KOROTINSKY , S.D. MALNICKS.D. MALNICK , and E. MORIELE. MORIEL View All Author Informationhttps://doi.org/10.1097/01.ju.0000095795.86327.b8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In cancer affected prostate cells lose the ability to concentrate zinc, resulting in a substantial decrease in Zn in the prostate. We investigated the possibility of using prostatic zinc combined with prostate specific antigen (PSA) as a novel tool for the reliable diagnosis of prostate cancer. Materials and Methods: Using the x-ray fluorescence method the Zn concentration was determined in vitro in prostate samples extracted by surgery from 28 patients. Clinical records included age, serum PSA, sextant prostate needle biopsy, previous medical therapy, surgical procedure and histological findings. Results: A new relationship was found between Zn in prostate tissue and PSA in blood, which allows improved separation between prostate cancer and benign prostate hyperplasia, and might have a significant impact on the reliable diagnosis of prostate cancer. Conclusions: Zn concentration is not uniform even in the same anatomical region of the prostate, so that a number of measurements at various locations are required for a diagnostic procedure. The most interesting finding in this study is the relationship between Zn concentration and PSA. A combination of these parameters represents a significant improvement on the diagnostic value of each of them separately and provides a powerful tool for more accurate diagnosis. Although the method may be applied in vitro on biopsy samples, our study underlines the importance of developing a facility for in vivo Zn determination in the prostate. References 1 : Diagnosis and staging of prostate cancer. In: . Philadelphia: W. B. Saunders Co.1998: 2519. chapt. 83. Google Scholar 2 : Clinical utility of measurements of free and total prostate-specific antigen (PSA): a review. Prostate1996; 7: 64. Google Scholar 3 : Use of percentage of free prostate-specific antigen to identify men at high risk of prostate cancer when PSA levels are 2.51 to 4 ng/mL and digital examination is not suspicious for prostate cancer: an alternative model. Urology1999; 54: 220. Google Scholar 4 : The male genital tract. In: Robbins Pathologic Basis of Disease. Philadelphia: W. B. Saunders Co.1999: 1029. Google Scholar 5 : Zinc and magnesium in human prostate gland: normal hyperplastic, and neoplastic. Cancer Res1967; 27: 1348. Google Scholar 6 : Concepts of citrate production and secretion by prostate. 1. Metabolic relationships. Prostate1991; 18: 25. Google Scholar 7 : Zinc causes a shift toward citrate at equilibrium of the m-aconitase reaction of the prostate mitochondria. J Inorg Biochem2000; 78: 161. Google Scholar 8 : Zinc and cadmium concentrations in whole tissue and separated epithelium and stroma from human benign prostatic hypertrophic glands. Prostate1985; 6: 177. Google Scholar 9 : Atomic absorption spectrophotometric determination of zinc in the prostate. Invest Urol1969; 6: 345. Google Scholar 10 : Distribution and concentration of zinc in the subcellular fractions of benign hyperplastic and malignant neoplastic human prostate. Exp Mol Pathol1973; 19: 139. Google Scholar 11 : Cancer of the prostate: early diagnosis by zinc and hormone analysis. Br J Cancer1979; 39: 700. Google Scholar 12 : Zinc and cadmium concentrations in indigenous blacks with normal, hypertrophic, and malignant prostate. Cancer1989; 63: 1388. Google Scholar 13 : Zinc and cadmium concentration in prostatic carcinoma of different histological grading in comparison to normal prostate tissue and adenofibromyomatosis (BPH). Urol Res1982; 10: 301. Google Scholar 14 : Zinc in the human prostate gland: normal, hyperplastic and cancerous. Int Urol Nephrol1997; 29: 565. Google Scholar 15 : Novel role of zinc in the regulation of citrate metabolism and its implications in prostate cancer. Prostate1998; 35: 285. Google Scholar 16 : Histologic grading and clinical staging of prostatic carcinoma. In: Urologic Pathology: The Prostate. Edited by . Philadelphia: Lea & Febiger1977: 171. part II. Google Scholar 17 Shilstein, S. Sh. Breskin, A., Chechik, R., Feldman, G., Vartsky, D.: In-vivo determination of prostatic Zn: phantom feasibility study. Unpublished data. Google Scholar From the Soreq NRC (DV), Yavne and Department of Particle Physics, Weizmann Institute of Science (SS, AB, AB, RC, SK) and Kaplan Medical Center (AB, MH, SK, SDM, EM), Rehovot, Israel© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology9 Nov 2018RE: PROSTATIC ZINC AND PROSTATE SPECIFIC ANTIGEN: AN EXPERIMENTAL EVALUATION OF THEIR COMBINED DIAGNOSTIC VALUE Volume 170Issue 6December 2003Page: 2258-2262 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsprostate-specific antigenprostatic neoplasmszincprostatespectrometry, x-ray emissionMetricsAuthor Information D. VARTSKY More articles by this author S. SHILSTEIN More articles by this author A. BERCOVICH Financial interest and/or other relationship with Pfizer Pharmaceuticals. More articles by this author M. HUSZAR More articles by this author A. BRESKIN More articles by this author R. CHECHIK More articles by this author S. KOROTINSKY More articles by this author S.D. MALNICK More articles by this author E. MORIEL More articles by this author Expand All Advertisement PDF downloadLoading ...
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We determine the influence of age, prostate volume, total serum prostate specific antigen (PSA) level and histological evidence of acute inflammation in biopsy specimens on the percent free serum PSA level in men without clinically detectable prostate cancer.We studied 70 men with total PSA levels of 2.6 to 9.9 ng./ml. who had undergone at least 3 sets of prostate biopsies that were negative for cancer as part of our PSA based prostate cancer screening program. Total and free PSA levels were measured using Hybritech immunoassays. Prostate volume and the presence of acute inflammation were determined from the most recent transrectal ultrasonography and prostate needle biopsy.Percent free PSA levels correlated significantly with age (r = 0.48, p = 0.0001) and prostate volume (r = 0.44, p = 0.0002) but not with total PSA (r = 0.04, p = 0.7). The mean percent free PSA did not differ for those with or without acute inflammation. Multivariate regression models demonstrated that age and prostate volume were significant predictors of percent free PSA.Among men without detectable prostate cancer and a total PSA level between 2.6 and 9.9 ng./ml. percent free serum PSA was higher in older men and in men with a larger prostate gland but was not influenced by total PSA level or the presence of acute inflammation in the prostatic biopsy specimen.
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OBJECTIVE To examine whether prostate‐specific antigen (PSA) levels adjusted according to prostate volume improve prostate cancer detection using transrected biopsies in men with PSA levels of 2–4 ng/mL, and benign findings on a digital rectal examination (DRE). PATIENTS AND METHODS Men aged ≤ 79 years and with serum PSA levels of 2–4 ng/mL and normal DRE findings were prospectively enrolled. Eligible patients were recommended for transrectal prostate biopsies after measuring prostate volumes with transrectal (TRUS) and transabdominal (TAUS) ultrasonography, and transition zone volumes with TRUS. In addition to PSA levels and the free‐to‐total PSA ratio, volume‐adjusted PSA levels, PSA densities determined by TRUS (PSAD TRUS ), and TAUS (PSAD TAUS ), and PSA transition zone densities (PSATzD) were compared using receiver operating characteristic analysis. RESULTS Prostate cancer was diagnosed in 31 (22%) of the 139 men who had prostate biopsies. The area under the curve (AUC) of PSAD TRUS (0.796) and PSATzD (0.792) was similar and significantly greater than that of PSA (AUC 0.588) and the free‐to‐total PSA ratio (AUC 0.658). PSAD TAUS was a significantly better indicator of prostate cancer than PSA levels alone ( P = 0.043). CONCLUSION As predictors of prostate cancer, there were no significant differences between PSAD TRUS and PSATzD. Although PSAD TAUS was worse than PSA variables adjusted by total and transition zone prostate volumes determined by TRUS, it was a better predictor than the PSA value alone in men with a low PSA level. These results indicate that TAUS is worthwhile where the routine use of TRUS before biopsy is difficult.
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