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Published on: April 9, 2019
Individualized Precision Prostate Biopsy Strategy for Patients With PI-RADS Score 2: A Retrospective Multicenter
Zhiyao Xu1,2, Yong Liang1,3, Zhiyong Zhang1,2
1Department of Urology, The First Affiliated Hospital of USTC, Centre for Leading Medicine and Advanced Technologies of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Background:
Prostate biopsy is currently the most common method of diagnosing prostate cancer (PCa). However, excessive biopsies not only cause physical and psychological pain to patients, but also increase the healthcare burden. We aimed to provide a biopsy strategy for patients with PI-RADS score 2 to improve the detection rate of clinically significant PCa (csPCa) while minimizing unnecessary prostate biopsies.
Methods:
This study retrospectively collected clinical data from patients undergoing prostate biopsy from three medical centers in China. The KD cohort was used as the primary analysis cohort, and the ZD and YJS cohorts were used as external validation cohorts. Diagnostic capacity of clinical variables was assessed using the receiver operating characteristic (ROC) curves and area under the curve (AUC) and compared with DeLong test. By plotting the relationship between csPCa risk and prostate-specific antigen density (PSAD) values using a locally estimated scatterplot smoothing(loess) function, the PSAD cutoff value corresponding to a clinically reasonable csPCa risk is determined. Prostate biopsy strategies are represented as simple decision tree diagrams. This study used csPCa as the only study endpoint.
Results:
By grouping patients with a cut-off value of PSAD ≥ 0.46 ng/ml, the detection rate of csPCa in the KD cohort of patients with a PI-RADS score of 2 increased from an initial 3.7-18.7%. And according to our proposed strategy would reduce unnecessary prostate biopsy by 86.5%, and at the same time could reduce the detection of clinically insignificant PCa (cisPCa) by 96.7%, at the cost of missing 1.3% of csPCa. The similar diagnostic performance was also shown in the ZD and YJS cohorts.
Conclusions:
The individualized precision prostate biopsy strategy is developed in this study, which can be used to make optimal decisions when faced with low-risk PCa (PI-RADS score 2) patients.
