Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 23;42(1):495.
doi: 10.1007/s00345-024-05202-y.

Development and validation of a novel nomogram to avoid unnecessary biopsy in patients with PI-RADS category ≥ 4 lesions and PSA ≤ 20 ng/ml

Hong Zeng #  1 , Yuntian Chen #  2 , Jinge Zhao #  1 , Jindong Dai #  1 , Yandong Xie  1 , Minghao Wang  1 , Qian Wang  1 , Nanwei Xu  1 , Junru Chen  1 , Guangxi Sun  3 , Hao Zeng  4 , Pengfei Shen  5
Affiliations

Development and validation of a novel nomogram to avoid unnecessary biopsy in patients with PI-RADS category ≥ 4 lesions and PSA ≤ 20 ng/ml

Hong Zeng et al. World J Urol. .

Abstract

Objectives: To develop and validate a prediction model for identifying non-prostate cancer (non-PCa) in biopsy-naive patients with PI-RADS category ≥ 4 lesions and PSA ≤ 20 ng/ml to avoid unnecessary biopsy.

Patients and methods: Eligible patients who underwent transperineal biopsies at West China Hospital between 2018 and 2022 were included. The patients were randomly divided into training cohort (70%) and validation cohort (30%). Logistic regression was used to screen for independent predictors of non-PCa, and a nomogram was constructed based on the regression coefficients. The discrimination and calibration were assessed by the C-index and calibration plots, respectively. Decision curve analysis (DCA) and clinical impact curves (CIC) were applied to measure the clinical net benefit.

Results: A total of 1580 patients were included, with 634 non-PCa. Age, prostate volume, prostate-specific antigen density (PSAD), apparent diffusion coefficient (ADC) and lesion zone were independent predictors incorporated into the optimal prediction model, and a corresponding nomogram was constructed ( https://nomogramscu.shinyapps.io/PI-RADS-4-5/ ). The model achieved a C-index of 0.931 (95% CI, 0.910-0.953) in the validation cohort. The DCA and CIC demonstrated an increased net benefit over a wide range of threshold probabilities. At biopsy-free thresholds of 60%, 70%, and 80%, the nomogram was able to avoid 74.0%, 65.8%, and 55.6% of unnecessary biopsies against 9.0%, 5.0%, and 3.6% of missed PCa (or 35.9%, 30.2% and 25.1% of foregone biopsies, respectively).

Conclusion: The developed nomogram has favorable predictive capability and clinical utility can help identify non-PCa to support clinical decision-making and reduce unnecessary prostate biopsies.

Keywords: Apparent diffusion coefficient; Biopsy; Multiparametric magnetic resonance imaging; Nomograms; PI-RADS; Prostatic neoplasms.

PubMed Disclaimer

References

    1. Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023. CA Cancer J Clin 73:17–48. https://doi.org/10.3322/caac.21763 - DOI - PubMed
    1. Schaeffer EM, Srinivas S, Adra N et al (2022) NCCN guidelines® insights: prostate cancer, version 1.2023. J Natl Compr Canc Netw 20:1288–1298. https://doi.org/10.6004/jnccn.2022.0063 - DOI - PubMed
    1. Park KJ, Choi SH, Lee JS, Kim JK, Kim MH, Jeong IG (2020) Risk stratification of prostate cancer according to PI-RADS® version 2 categories: meta-analysis for prospective studies. J Urol 204:1141–1149. https://doi.org/10.1097/ju.0000000000001306 - DOI - PubMed
    1. Oerther B, Engel H, Bamberg F, Sigle A, Gratzke C, Benndorf M (2022) Cancer detection rates of the PI-RADSv2.1 assessment categories: systematic review and meta-analysis on lesion level and patient level. Prostate Cancer Prostatic Dis 25:256–263. https://doi.org/10.1038/s41391-021-00417-1 - DOI - PubMed
    1. Mazzone E, Stabile A, Pellegrino F et al (2021) Positive predictive value of prostate imaging reporting and data system version 2 for the detection of clinically significant prostate cancer: a systematic review and meta-analysis. Eur Urol Oncol 4:697–713. https://doi.org/10.1016/j.euo.2020.12.004

Publication types

Substances

LinkOut - more resources