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Updated: Jun 20, 2026
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Detection and Isolation of Cancer in Prostate Biopsies Using Stimulated Raman Histology and Artificial Intelligence
Published on: June 10, 2025
A risk-based strategy improves prostate-specific antigen-driven detection of prostate cancer
Monique J Roobol1, Ewout W Steyerberg, Ries Kranse
1Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. m.roobol@erasmusmc.nl
European Urology
|September 8, 2009
Summary
Developing an individualized prostate cancer screening algorithm can significantly reduce unnecessary biopsies. This approach uses prebiopsy information alongside PSA levels, ensuring detection of most clinically important prostate cancer cases.
Area of Science:
- Urology
- Oncology
- Medical Diagnostics
Background:
- Prostate cancer (PC) screening efficiency remains debated due to diagnostic uncertainties.
- Current screening methods may lead to overdiagnosis and overtreatment of indolent cancers.
Purpose of the Study:
- To devise strategies for minimizing unnecessary prostate cancer biopsies.
- To maintain high detection rates for clinically significant prostate cancer cases.
Main Methods:
- A logistic regression model incorporating PSA, ultrasound volume, digital rectal exam, and transrectal ultrasound was developed.
- Calculated probability of positive biopsy [P(biop+)] and probability of indolent cancer [P(ind)] were used to refine screening criteria.
- Analysis included initial screening data from 1850 men and repeat screening data from 1201 men.
Main Results:
- Applying a P(biop+) cut-off of 12.5% at initial screening could have avoided 33% of biopsies, increasing positive predictive value (PPV) to 38%.
- At repeat screening, a similar cut-off increased PPV from 19% to 25% and could have avoided 33% of biopsies.
- This strategy would miss 13% of PC cases, predominantly indolent ones (70-81%), while avoiding detection of deadly PC cases.
Conclusions:
- An individualized screening algorithm integrating prebiopsy data with PSA levels effectively reduces unnecessary biopsies.
- This approach balances the reduction of invasive procedures with the detection of critical prostate cancer cases.
- The proposed method minimizes the risk of missing life-threatening prostate cancer diagnoses.
