Initial Application Of Clinical Parameters And Models In The Diagnosis Of Transition Zone Prostate Cancer

Part Ⅰ Screening Independent Risk Factors for Transition Zone PCa and csPCa,Construction of a Diagnostic Model and Evaluation of Their Diagnostic EfficacyObjective:To screen independent risk factors for prostate cancer(PCa)and clinically significant prostate cancer(csPCa)in the transition zone,construct a diagnostic model,and explore the diagnostic efficacy and clinical application value of the independent risk factors and diagnostic model for these diseases.Materials and Methods:A retrospective analysis was performed on the case data of patients with prostate transition zone disease who underwent 3.0T MRI examination(including T2WI and DWI sequences)in the Second Affiliated Hospital of Suzhou University from January 2017 to December 2021 and were pathologically confirmed by prostate system puncture biopsy.The enrolled patients were determined according to the admission and exclusion criteria.The research indicators included age,prostate-specific antigen(PSA),free prostate-specific antigen(fPSA),ratio of free to total prostatespecific antigen(f/t PSA),prostate volume(PV).transition zone volume(TZV).prostate-specific antigen density(PSAD:tPSA÷PV),transition zone prostate-specific antigen density(TZ-PSAD:tPSA÷TZV),lesion location and PI-RADS V2.1 score.According to the pathological diagnosis results,the included study patients were grouped into a prostate cancer(PCa)group and a non-PCa group and a clinically significant prostate cancer(csPCa:GS≥7)group versus a non-csPCa group.The differences between the PCa group and non-PCa group and between the csPCa group and non-csPCa group were assessed with the independent samples t test,the MannWhitney U test or the chi-square test,and the indicators that were significantly different between the groups were included in multivariate logistic regression analysis.The independent risk factors for transition-zone PCa and csPCa were selected and used to construct transition zone PCa and csPCa diagnostic models.The performance of the selected independent risk factors and the constructed diagnostic models in the diagnosis of PCa and csPCa in the transition zone was evaluated by receiver operating characteristic(ROC)curve analysis for the independent risk factors and the Z-test for the constructed diagnostic models.The areas under the ROC curve(AUCs)of the risk factors and models in the diagnosis of transition zone PCa and csPCa were compared,and p<0.05 indicated statistical significance.Results:A total of 456 patients with prostate transition zone disease were included in this group of studies,with an age range of 46 to 95 years and an average age of 71.2±7.98 years.Of these,114 patients with PCa were included,including 74 with csPCa(GS=3+4:20 cases,GS=4+3:12 cases,GS=4+4:27 cases,GS=4+5:6 cases,GS=5+4:4 cases,GS=5+5:5 cases)and 342 cases without PCa(including 39 with inflammation and 303 with hyperplasia).There were significant differences in patient age,PSA,fPSA,f/t PSA,PV,TZV.PS AD,TZ-PSAD,and PI-RADS V2.1 score(p<0.05)between the PCa and non-PCa groups and the csPCa and non-csPCa groups.Multivariate logistic regression analysis showed that PI-RADS V2.1 score,PSAD,and TZ-PSAD were independent risk factors for transition zone PCa and csPCa(p<0.05).Diagnostic model A1(PI-RADS V2.1+TZ-PSAD)was constructed to distinguish PCa with non-PCa in the transition zone,and diagnostic models A2(PI-RADS V2.1+PSAD)and B2(PI-RADS V2.1+TZ-PSAD)were constructed to differentiate between transition zone csPCa and non-csPCa.The AUCs of the PI-RADS V2.1 score,PSAD.TZ-PSAD,and diagnostic models A1 and B1 in discriminating transition zone PCa were as follows from largest to smallest:Model B1(0.869),Model A1(0.865),PI-RADS V2.1 score(0.84),TZ-PSAD(0.827),and PSAD(0.799);the AUCs of the PI-RADS V2.1 score.PSAD,TZ-PSAD,and diagnostic models A2 and B2 in discriminating transition zone csPCa was as follows from largest to smallest:Model B2(0.932),Model A2(0.922),PI-RADS V2.1 score(0.901),TZ-PSAD(0.883),and PSAD(0.838).The AUCs in discriminating transition zone PCa of diagnostic models A1 and B1 were not significantly different(z value 1.123,p=0.2613),while those of diagnostic models A2 and B2 in discriminating transition zone csPCa were(z value 2.662,p=0.0078).Conclusion:The results were as follows:1.PSAD,TZ-PSAD,and PI-RADS V2.1 were independent predictors of PCa and csPCa in the transition zone;2.Among diagnostic models A1(PI-RADS V2.1+PSAD)and B1(PI-RADS V2.1+TZ-PSAD),diagnostic model B1 has the highest diagnostic efficiency for transition zone PCa;3.Among diagnostic models A2(PI-RADS V2.1+PSAD)and B2(PI-RADS V2.1+TZPSAD),diagnostic model B2 has the highest diagnostic efficiency for Transition Zone csPCa;4.Diagnostic models B1 and B2 have potential clinical application value in the diagnosis and evaluation of prostate transition zone lesions.Part Ⅱ Diagnostic efficacy of relevant clinical indicators for PIRADS V2.1 category 3 transition zone cancer lesionsObjective:To investigate the diagnostic efficacy and application value of relevant clinical indicators in transition zone cancer lesions(PCa and csPCa)with a PI-RADS V2.1 category 3 lesions.Materials and methods:This was a retrospective analysis of 3.0 T MRI(including T2WI and DWI sequences)data obtained between January 2017 and December 2021 at the Second Affiliated Hospital of Soochow University.The case data of patients with prostate migration lesions confirmed by prostate system puncture biopsy and a PIRADS V2.1 category 3 lesions were extracted.The included study patients were grouped according to the pathological diagnosis results into a PCa group and a non-PCa group as well as a csPCa group and a non-csPCa group.Clinical of the study included age,prostate-specific antigen(PSA),free PSA(fPSA),ratio of the free to total PSA(f/t PSA),prostate volume(PV),transition zone volume(TZV),PSA density(PSAD),and transition zone PSAD(TZ-PSAD).The differences between the PCa group and nonPCa group and between the csPCa group and non-csPCa group were compared and analyzed with the independent sample t test or the Mann-Whitney U test,and indices that were significantly different between the groups were selected.Receiver operating characteristic(ROC)curve analysis was used to assess the diagnostic efficacy of each index for transition zone PCa and csPCa lesions with a PI-RADS V2.1 category 3 lesions,and the Youden index was used to determine the optimal diagnostic threshold and the corresponding diagnostic sensitivity and specificity.The Z test was used to compare the differences in the area under the ROC curve(AUC)of each research index in diagnosing PCa and csPCa,and P<0.05 indicated statistical significance.Results:A total of 149 lesions were finally included in this study.There were 24 cases in the PCa group,including 10 in the csPCa group(GS=3+4,4 cases,GS=4+3,4 cases,GS=4+4,1 case,GS=4+5,1 case).Statistical analysis showed that there were significant differences in f/t PSA,PSAD,TZ-PSA,TZV,and PV between the PCa group and the non-PCa group(p<0.05).There were also significant differences in TZPSAD,TZV,and PV between the csPCa group and the non-csPCa group(P<0.05).ROC curve analysis for PCa lesions(PI-RADS V2.1 category 3 lesions)in the transition zone diagnosed by each index revealed the following AUCs from largest to smallest:TZ-PSAD(0.737),TZV(0.725),PV(0.677),f/t PSA(0.648),and PSAD(0.644).Similarly,the indices sorted from largest to smallest AUC in diagnosing transition zone csPCa(PI-RADS V2.1 category 3 lesions)were as follows:TZ-PSAD(0.800),TZV(0.789),PV(0.727).The highest AUC values in diagnosing transition zone PCa(0.737)and transition zone csPCa(0.800)were achieved by TZ-PSAD.Analysis of the AUCs in diagnosing transition zone PCa showed that the differences between the AUCs of PV and TZV and between those of PSAD and TZ-PSAD were statistically significant(p<0.05),while the difference between the remaining two indices was not statistically significant(p>0.05).In a similar analysis for transition zone csPCa,the AUCs of TZPSAD,TZV,and PV were not significantly different among each other(p>0.05).For transition zone lesions with a PI-RADS V2.1 category 3 lesions,if TZ-PSAD>0.2 ng/ml/ml was taken as the cutoff value,the sensitivity in diagnosing transition zone PCa was 83.33%,and the specificity was 58.40%,meaning that 48.3%(72/149)of unnecessary punctures were avoided,while 4 cases of PCa were missed,and approximately 35.57%(53/149)were needlessly punctured.If TZ-PSAD>0.258 ng/ml/ml/ml was taken as the cutoff value,the sensitivity in diagnosing transition zone csPCa was 90%,and the specificity was 71.22%,meaning that 65.77%(98/149)of unnecessary punctures were avoided.Only one case of csPCa was missed,and approximately 27.51%(41/149)suffered unnecessary puncture.Conclusion:The results of this study showed that TZ-PSAD,TZV,and PSAD can assist in evaluating whether a category 3 PI-RADS V2.1 transition zone lesion is PCa,with TZ-PSAD showing the highest diagnostic efficacy.Similarly,TZ-PSAD,TZV,and PV can assist in evaluating whether these lesions are csPCa,and again,TZ-PSAD had the highest diagnostic efficiency.These findings suggest that TZ-PSAD may have clinical application value in improving the detection rate of PCa(especially csPCa)in transition zone lesions with PI-RADS V2.1 category 3,reducing unnecessary puncture,and providing effective information for hierarchical management of clinical cases of these lesions.