Predicting clinically significant prostate cancer in elderly patients: A nomogram approach with shear wave...

Area of Science:

• Urology
• Medical Imaging
• Oncology

Background:

• Prostate cancer (PCa) diagnosis in elderly men often relies on invasive biopsies.
• Accurate detection of clinically significant prostate cancer (csPCa) is crucial for appropriate treatment.
• Shear wave elastography (SWE) offers a non-invasive method to assess tissue stiffness, potentially aiding PCa detection.

Purpose of the Study:

• To develop and validate a nomogram incorporating SWE parameters for detecting csPCa in elderly individuals.
• To assess the diagnostic performance and clinical utility of the developed nomogram.

Main Methods:

• A cohort of 290 elderly men with suspected PCa underwent prostate biopsy and SWE imaging.
• The LASSO algorithm and logistic regression were used to build the nomogram, including features like Emean, ΔEmean, prostate volume, prostate-specific antigen density (PSAD), and transrectal ultrasound (TRUS).
• Receiver operating characteristic (ROC) curves, calibration curves, decision curves, and clinical impact curves were used for validation and assessment of clinical usefulness.

Main Results:

• The nomogram demonstrated strong discriminatory ability with an AUC of 0.89 (95% CI: 0.83-0.94), outperforming a clinical model without SWE parameters.
• The nomogram achieved an accuracy of 0.83, sensitivity of 0.89, and specificity of 0.78.
• Utilizing a 20% probability threshold, the nomogram reduced biopsies by 25% without missing any csPCa cases, showing improved clinical impact.

Conclusions:

• The developed nomogram effectively identifies elderly men with csPCa.
• This tool aids in informed clinical decision-making by providing accurate diagnostic outcomes.
• The nomogram offers significant clinical benefits by reducing unnecessary biopsies and improving diagnostic accuracy.