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A new predictor is comparable to the updated nomogram in predicting the intermediate- and high-risk prostate cancer but outperforms nomogram in reducing the overtreatment for the low-risk Pca

Authors Wang H, Tai S, Zhang L, Zhou J, Liang C

Received 12 November 2018

Accepted for publication 21 March 2019

Published 30 April 2019 Volume 2019:11 Pages 3753—3763


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo

Hui Wang,1–3 Sheng Tai,1,2 Li Zhang,1,3 Jun Zhou,1–3 Chaozhao Liang1–3

1Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 2Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, People’s Republic of China; 3The Institute of Urology, Anhui Medical University, Hefei, People’s Republic of China

Purposes: To develop a new predictor and update nomogram based on prostate imaging reporting and data system version 2 (PI-RADS V2) in predicting intermediate- and high-risk prostate cancer (IH-Pca) and reducing the overtreatment for low-risk Pca (L-Pca).
Methods: All men that underwent trans-rectal ultrasound-guided 12+X-core prostate biopsy between January 2015 and June 2018 were collected and analyzed. The significant risks (SRs) of Pca were selected by univariate and multivariate analysis. All SRs were divided into four groups (0 to 3 points) based on the probability of PI-RADS. Each patient can obtain a total score (TS). The updated nomogram was established by R package version 3.0. The area under the curve (AUC), net reclassification index (NRI), calibration curves and decision curves were used to evaluate the diagnostic performance.
Results: There were 1,078 patients, including 640 (59%) men with normal or L-Pca (N-LPca) and 438 (41%) men with IH-Pca. The scores of TS for IH-Pca and N-LPca were 16.13±3.11 and 10.52±3.32, respectively (P<0.01). The discriminative power of TS and nomogram was comparable in predicting IH-Pca (AUCs: 0.88 vs 0.87, P=0.89), and both were greater than PSA and PI-RADS (AUCs: 0.76 vs 0.80). For NRI, NRITS vs nomogram was 1.31% (P=0.55), NRITS vs PSA was 24.13% (P<0.001) and NRITS vs PI-RADS was 13.19% (P<0.001). Compared with PSA, PI-RADS and nomogram, TS can reduce the number of unnecessary biopsies, up to 71%, 60% and 38%, respectively.
Conclusion: The new predictor is comparable to the updated nomogram in predicting IH-Pca, and both are better than PSA and PI-RADS. In addition, the new predictor slightly outperforms nomogram in reducing the unnecessary biopsies for L-Pca and being convenient to use.

Keywords: age, PSA, PSA density, prostate cancer detection, PI-RADS, nomogram

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