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Comparison of PSA-density of the transition zone and whole gland for risk stratification of men with suspected prostate cancer: A retrospective MRI-cohort study


Schneider, Aurelia F; Stocker, Daniel; Hötker, Andreas M; Eberli, Daniel; Rupp, Niels J; Donati, Olivio F; Becker, Anton S (2019). Comparison of PSA-density of the transition zone and whole gland for risk stratification of men with suspected prostate cancer: A retrospective MRI-cohort study. European Journal of Radiology, 120:108660.

Abstract

PURPOSE: To compare the correlation of transition zone prostate-specific antigen density (TZPSAD) versus whole gland (WG) density (PSAD) with Gleason score.
METHODS: In this single-center, retrospective cohort study, men undergoing MRI of the prostate in 2015 and 2016 who had a transperineal template saturation biopsy within 6 months of MRI were included (n = 178; median age 64 y, interquartile range [IQR] 58-68 y; PSA 6.6 ng/ml, 4.6-9.7 ng/ml). The WG and TZ were segmented voxel-wise on T2-weighted transverse planes. The volumes and corresponding PSA-densities were calculated. Correlations with the Gleason score were assessed with Spearman's rho. Optimal thresholds of the PSA densities were computed using the Youden Index of the receiver-operating-characteristics curve. A p-value of ≤ 0.05 was considered statistically significant.
RESULTS: Median WG volume was 45 ml (IQR: 33.9-58.7 ml, range: 17.2-165.3 ml), median volume of the TZ was 27.3 ml (IQR: 19.2-39.3 ml, range: 9.0-141.1 ml). Both PSA density values, PSAD and TZPSAD, correlated significantly with the Gleason score: The PSAD (rho = 0.39) showed significantly weaker correlation than the TZPSAD (rho = 0.44, p = 0.05). ROC analysis revealed an ideal cut-off of 0.15 ng/ml2 for PSAD (95%-CI: 0.09-0.16 ng/ml2) and 0.22 ng/ml2 for the TZPSAD (0.15-0.32 ng/ml2) for discrimination between Gleason 3 + 4 and 4 + 3.
CONCLUSION: The TZPSAD exhibited a stronger correlation with cancer dedifferentiation than PSAD and may thus be a better surrogate marker for cancer aggressiveness than PSAD. Moreover, the TZPSAD threshold of 0.22 ng/ml2 may help in risk stratification of men with suspected PCa.

Abstract

PURPOSE: To compare the correlation of transition zone prostate-specific antigen density (TZPSAD) versus whole gland (WG) density (PSAD) with Gleason score.
METHODS: In this single-center, retrospective cohort study, men undergoing MRI of the prostate in 2015 and 2016 who had a transperineal template saturation biopsy within 6 months of MRI were included (n = 178; median age 64 y, interquartile range [IQR] 58-68 y; PSA 6.6 ng/ml, 4.6-9.7 ng/ml). The WG and TZ were segmented voxel-wise on T2-weighted transverse planes. The volumes and corresponding PSA-densities were calculated. Correlations with the Gleason score were assessed with Spearman's rho. Optimal thresholds of the PSA densities were computed using the Youden Index of the receiver-operating-characteristics curve. A p-value of ≤ 0.05 was considered statistically significant.
RESULTS: Median WG volume was 45 ml (IQR: 33.9-58.7 ml, range: 17.2-165.3 ml), median volume of the TZ was 27.3 ml (IQR: 19.2-39.3 ml, range: 9.0-141.1 ml). Both PSA density values, PSAD and TZPSAD, correlated significantly with the Gleason score: The PSAD (rho = 0.39) showed significantly weaker correlation than the TZPSAD (rho = 0.44, p = 0.05). ROC analysis revealed an ideal cut-off of 0.15 ng/ml2 for PSAD (95%-CI: 0.09-0.16 ng/ml2) and 0.22 ng/ml2 for the TZPSAD (0.15-0.32 ng/ml2) for discrimination between Gleason 3 + 4 and 4 + 3.
CONCLUSION: The TZPSAD exhibited a stronger correlation with cancer dedifferentiation than PSAD and may thus be a better surrogate marker for cancer aggressiveness than PSAD. Moreover, the TZPSAD threshold of 0.22 ng/ml2 may help in risk stratification of men with suspected PCa.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Institute of Pathology and Molecular Pathology
04 Faculty of Medicine > University Hospital Zurich > Urological Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:7 September 2019
Deposited On:31 Oct 2019 14:37
Last Modified:16 Dec 2019 09:31
Publisher:Elsevier
ISSN:0720-048X
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.ejrad.2019.108660
PubMed ID:31546123

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