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| Diagnostic value comparison of the combination of prostate-specific membrane antigen-body PET/MR and the prostate health index with each alone in early diagnosis of prostate cancer |
Jiacheng Liua,Xiaoyi Linb,Da Huanga,Miao Zhangc,Ao Liua,Xiaohao Ruana,Jingrong Jiangd,Hai Huanga,Lu Chena,*( ),Danfeng Xua,*()
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aDepartment of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
bDepartment of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
cDepartment of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
dShanghai Yuye Medical Technology Co. Ltd, Shanghai, China |
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Abstract Objective: This study aimed to figure out whether the combination of the prostate health index (PHI) and prostate-specific membrane antigen (PSMA)-PET/MR could improve the diagnostic accuracy for prostate cancer (PCa) than that of each individual method used alone. Methods: In this prospective, observational study, 41 patients who underwent the systematic prostate biopsy between June 2019 and September 2022 were enrolled. Both the PHI test and 18F-PSMA-1007-PET/MR were performed prior to biopsies. The diagnostic accuracy of different models was compared by logistic regression, areas under the curve (AUCs) of the receiver operating characteristic, and net reclassification index (NRI). Results: Among the 41 patients, 14 (34.1%) were pathologically diagnosed with PCa. The PHI in the PCa group was significantly higher than that in the benign group (44.4 vs. 35.0, p=0.048). Similarly, all the patients in the PCa group received positive results of 18F-PSMA-1007-PET/MR, of which the positive rate was significantly higher than that in benign group (100% vs. 62.96%, p=0.025). The 18F-PSMA-1007-PET/MR provided additional diagnostic values to the PHI (AUC: 0.802 vs. 0.692, p=0.025). However, there was no significant difference between the combination model and the 18F-PSMA-1007-PET/MR alone (AUC 0.802 vs. 0.685, p=0.071). The optimal PHI cutoff of the combination model is 32, with which the model could significantly reduce unnecessary biopsies (NRI: 22.22%, 95% confidence interval: 6.54%-37.90%, p=0.005). However, among patients with the PHI of ≥43.5, there was no significant difference between the combination model and the PHI alone (NRI:11.11%, 95% confidence interval: -0.74%-22.97%, p=0.066). Conclusion: The combination of the PHI and 18F-PSMA-1007-PET/MR outperforms the PHI alone for predicting PCa, especially in avoiding unnecessary biopsies. However, for patients with the PHI of ≥43.5, the addition of 18F-PSMA-1007-PET/MR to the PHI does not yield additional benefits.
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Received: 21 July 2023
Available online: 20 October 2024
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Corresponding Authors:
*E-mail address: cl12063@rjh.com.cn (L. Chen), xdf12036@rjh.com.cn (D. Xu).
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| Variable | Total (n=41) | Biopsy positive (n=14) | Biopsy negative (n=27) | p-Value | | Age, year | 62.0 (56.0-67.0) | 67.0 (63.0-74.0) | 59.0 (56.0-62.5) | 0.054a | | tPSA, ng/mL | 9.01 (6.04-10.63) | 7.42 (5.77-10.82) | 9.73 (7.24-10.55) | 0.394b | | fPSA, ng/mL | 1.18 (0.71-1.80) | 1.05 (0.67-1.73) | 1.40 (0.82-1.76) | 0.450b | | f/tPSA | 0.13 (0.10-0.17) | 0.13 (0.09-0.18) | 0.14 (0.10-0.17) | 0.847b | | p2PSA | 14.3 (10.1-25.1) | 15.0 (12.1-25.0) | 13.1 (9.8-23.4) | 0.322b | | PHI | 38.1 (30.6-47.7) | 44.4 (33.1-55.1) | 35.0 (28.8-43.6) | 0.048b | | PV, cm3 | 48.1 (39.4-56.3) | 41.5 (27.4-64.0) | 48.2 (38.7-54.2) | 0.711b | | PSAD, ng/mL2 | 0.20 (0.15-0.24) | 0.16 (0.12-0.23) | 0.20 (0.17-0.25) | 0.294b | | SUVmax | 7.70 (5.73-13.20) | 10.15 (7.03-14.60) | 7.30 (5.44-10.60) | 0.132b | | 18F-PSMA-PET/MR positive | 31 (75.61) | 14 (100) | 17 (62.96) | 0.025c | | Leision | | Central zone | 5 (12.20) | 1 (7.14) | 4 (14.81) | NA | | Peripheric zone | 13 (31.71) | 8 (57.14) | 5 (18.52) | NA | | Transitional zone | 13 (31.71) | 5 (35.71) | 8 (29.63) | NA | | Diameter, cm | 0.80 (0.65-1.20) | 1.10 (0.73-1.50) | 0.70 (0.50-1.10) | NA | | Repeated biopsy | 7 (17.07) | 2 (14.29) | 5 (18.52) | 0.750 |
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Basic patient characteristics.
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Receiver operating characteristic curves analysis: comparing PHI, 18F-PMSA-PET/MR, and the combination. PHI, prostate health index; PSMA, prostate-specific membrane antigen.
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The changing trend of the AUC of the PHI and combination under different cutoffs. The vertical line represents the cutoff point where AUC values of both the PHI and combination model reach equality. AUC, area under the curve; PHI, prostate health index.
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| PHI cutoff | PHI vs. combination | PHI vs. 18F-PSMA-1007-PET/MR | | PCa missed (%) | Biopsy avoided (%) | NRI (95% CI) (%) | p-Value | PCa missed (%) | Biopsy avoided (%) | NRI (95% CI) (%) | p-Value | | 25 | 0 | 25.93 | 25.93 (9.40-42.46) | 0.002 | -7.14 | 14.81 | 21.96 (-4.08-47.99) | 0.098 | | 30 | 0 | 22.22 | 22.22 (6.54-37.90) | 0.005 | -7.14 | 3.70 | 10.85 (-16.72-38.41) | 0.441 | | 32a | 0 | 22.22 | 22.22 (6.54-37.90) | 0.005 | -7.14 | -14.29 | 6.88 (-25.77-39.53) | 0.680 | | 35 | 0 | 18.52 | 18.52 (3.87-33.17) | 0.013 | -35.71 | -11.11 | 24.60 (-11.42-60.62) | 0.181 | | 40 | 0 | 14.81 | 14.81 (1.41-28.21) | 0.030 | -42.86 | -25.93 | 16.93 (-20.04-53.90) | 0.369 | | 43.5b | 0 | 7.32 | 11.11 (-0.74-22.97) | 0.066 | -37.04 | -50.00 | 12.96 (-23.56-49.49) | 0.487 | | 45 | 0 | 7.41 | 7.41 (-2.47-17.29) | 0.142 | -50.00 | -40.74 | 9.26 (-25.96-44.48) | 0.606 | | 50 | 0 | 0 | 0 | NA | -64.29 | -51.85 | 12.43 (-18.95-43.82) | 0.438 |
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The NRI of the combination model and 18F-PSMA-1007-PET/MR compared to the PHI under different cutoffs.
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| PHI | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | Youden index | | 25 | 92.86 | 48.15 | 48.15 | 92.86 | 0.410 | | 30 | 92.86 | 55.56 | 52.00 | 93.75 | 0.484 | | 32a | 85.71 | 66.67 | 57.14 | 90.00 | 0.524 | | 35 | 64.29 | 66.67 | 50.00 | 78.26 | 0.310 | | 40 | 57.14 | 77.78 | 57.14 | 77.78 | 0.349 | | 45 | 50.00 | 85.19 | 63.64 | 76.67 | 0.352 | | 50 | 35.71 | 88.89 | 62.50 | 72.73 | 0.246 |
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Sensitivity, specificity, PPV, and NPV of the combination under different PHI cutoffs.
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