Abstract：
BACKGROUND: Prebiopsy prostate-specific antigen density (PSAD) is a well-known predictor of clinically significant prostate cancer (csPCa). Since prostate-specific antigen (PSA) and prostate volume (PV) increase normally with aging, PSAD thresholds may vary. The purpose of the study was to determine if PSAD was predictive of csPCa in different age strata.
METHODS: We retrospectively reviewed our institutional database for patients who underwent multiparametric magnetic resonance imaging (MRI) between January 2016 and December 2021. We included patients who had post-MRI prostate biopsies. Based on age, we divided our cohort into four subgroups (groups 1-4): <55, 55-64, 65-74, and ≥75 years old. PSAD accuracy was estimated by the area under the curve (AUC) as a predictive model for differentiating csPCa between the groups. CsPCa was defined as a Gleason Grade Group 2 or higher. Three different PSAD thresholds (0.1, 0.15, and 0.2) were tested across the groups for sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV). Chi-square and analysis of variance tests were used for bivariate analysis. All analys were completed using R 4.3 (R Core Team, 2023).
RESULTS: Among 1913 patients, 883 (46.1%) had prostate biopsies. In groups 1, 2, 3, and 4, there were 62 (7%), 321 (36.4%), 404 (45.8%), and 96 (10.9%) patients, respectively. Median PSA was 5.6 (interquartile range 3.4-8.1), 6.2 (4.8-9), 6.8 (5.1-9.7), and 9 (5.6-13), respectively (p < 0.01). Median PV was 42.3 (30-62), 51 (36-77), 55.5 (38-85.9), and 59.3 (42-110) mL, respectively (p < 0.01). No difference was observed in median PSAD between age groups 1-4 (0.1 [0.07-0.16], 0.11 [0.08-0.18], 0.1 [0.07-0.19], and 0.1 [0.07-0.2]), respectively (p = 0.393). CsPCa was diagnosed in 241 (27.3%) patients, of which 10 (16.1%), 65 (20.2%), 121 (30%), and 45 (46.7%) were in groups 1-4, respectively (p < 0.001). For groups 1-4, the PSAD AUC for predicting csPCa was 0.75, 0.68, 0.71, and 0.74. While testing PSAD threshold of 0.15 across the different age groups (1-4), the PPV vs. NPV was 39.1 vs. 93.2, 33.6 vs. 87, 50.9 vs. 80.8, and 66.1 vs. 64.7, respectively.
CONCLUSIONS: PSAD prediction model was found to be similar among different age groups. In young patients, PSAD had a high NPV but low PPV. With increasing age, the opposite trend was observed, likely due to higher disease prevalence. While PSAD thresholds may be less useful in older patients to rule out higher-grade prostate cancer, the clinical consequences of these diagnoses require a case-by-case evaluation.
METHODS: We retrospectively reviewed our institutional database for patients who underwent multiparametric magnetic resonance imaging (MRI) between January 2016 and December 2021. We included patients who had post-MRI prostate biopsies. Based on age, we divided our cohort into four subgroups (groups 1-4): <55, 55-64, 65-74, and ≥75 years old. PSAD accuracy was estimated by the area under the curve (AUC) as a predictive model for differentiating csPCa between the groups. CsPCa was defined as a Gleason Grade Group 2 or higher. Three different PSAD thresholds (0.1, 0.15, and 0.2) were tested across the groups for sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV). Chi-square and analysis of variance tests were used for bivariate analysis. All analys were completed using R 4.3 (R Core Team, 2023).
RESULTS: Among 1913 patients, 883 (46.1%) had prostate biopsies. In groups 1, 2, 3, and 4, there were 62 (7%), 321 (36.4%), 404 (45.8%), and 96 (10.9%) patients, respectively. Median PSA was 5.6 (interquartile range 3.4-8.1), 6.2 (4.8-9), 6.8 (5.1-9.7), and 9 (5.6-13), respectively (p < 0.01). Median PV was 42.3 (30-62), 51 (36-77), 55.5 (38-85.9), and 59.3 (42-110) mL, respectively (p < 0.01). No difference was observed in median PSAD between age groups 1-4 (0.1 [0.07-0.16], 0.11 [0.08-0.18], 0.1 [0.07-0.19], and 0.1 [0.07-0.2]), respectively (p = 0.393). CsPCa was diagnosed in 241 (27.3%) patients, of which 10 (16.1%), 65 (20.2%), 121 (30%), and 45 (46.7%) were in groups 1-4, respectively (p < 0.001). For groups 1-4, the PSAD AUC for predicting csPCa was 0.75, 0.68, 0.71, and 0.74. While testing PSAD threshold of 0.15 across the different age groups (1-4), the PPV vs. NPV was 39.1 vs. 93.2, 33.6 vs. 87, 50.9 vs. 80.8, and 66.1 vs. 64.7, respectively.
CONCLUSIONS: PSAD prediction model was found to be similar among different age groups. In young patients, PSAD had a high NPV but low PPV. With increasing age, the opposite trend was observed, likely due to higher disease prevalence. While PSAD thresholds may be less useful in older patients to rule out higher-grade prostate cancer, the clinical consequences of these diagnoses require a case-by-case evaluation.
摘要：
背景：活检前前列腺特异性抗原密度（PSAD）是临床上有意义的前列腺癌（csPCa）的众所周知的预测指标。由于前列腺特异性抗原（PSA）和前列腺体积（PV）随着年龄的增长而正常增加，PSAD阈值可以变化。该研究的目的是确定PSAD是否可预测不同年龄阶层的csPCa。
方法：我们回顾性回顾了2016年1月至2021年12月期间接受多参数磁共振成像（MRI）患者的机构数据库。我们纳入了MRI后前列腺活检的患者。根据年龄,我们将队列分为4个亚组(1-4组):<55,55-64,65-74和≥75岁.通过曲线下面积(AUC)作为用于区分组间csPCa的预测模型来估计PSAD准确性。CsPCa被定义为格里森等级组2或更高。三个不同的PSAD阈值（0.1，0.15和0.2）在组间进行了敏感性测试，特异性，阳性预测值(PPV)和阴性预测值(NPV)。卡方和方差分析用于双变量分析。所有分析均使用R4.3(R核心团队，2023年）。
结果：在1913名患者中，883（46.1％）进行了前列腺活检。在第1、2、3和4组中，有62（7％），321（36.4%），404（45.8%），96名(10.9%)患者，分别。PSA中位数为5.6（四分位数范围3.4-8.1），6.2(4.8-9),6.8(5.1-9.7),和9（5.6-13），分别(p<0.01)。中位数PV为42.3（30-62），51（36-77）55.5（38-85.9），和59.3（42-110）毫升，分别(p<0.01)。1-4岁年龄组的中位PSAD无差异（0.1[0.07-0.16]，0.11[0.08-0.18],0.1[0.07-0.19],和0.1[0.07-0.2])，分别（p=0.393）。CsPCa在241例（27.3％）患者中被诊断出，其中10人（16.1%），65（20.2%），121（30%），第1-4组分别为45例（46.7％）（p<0.001）。对于组1-4,预测csPCa的PSADAUC为0.75、0.68、0.71和0.74。在不同年龄组(1-4)测试0.15的PSAD阈值时，PPV与NPV为39.1vs.93.2,33.6vs.87，50.9vs.80.8和66.1vs.分别为64.7。
结论：PSAD预测模型在不同年龄组间相似。在年轻患者中，PSAD具有高NPV但低PPV。随着年龄的增长,观察到相反的趋势，可能是由于较高的疾病患病率。虽然PSAD阈值在老年患者中可能不太有用，以排除更高级别前列腺癌，这些诊断的临床后果需要逐例评估.
方法：我们回顾性回顾了2016年1月至2021年12月期间接受多参数磁共振成像（MRI）患者的机构数据库。我们纳入了MRI后前列腺活检的患者。根据年龄,我们将队列分为4个亚组(1-4组):<55,55-64,65-74和≥75岁.通过曲线下面积(AUC)作为用于区分组间csPCa的预测模型来估计PSAD准确性。CsPCa被定义为格里森等级组2或更高。三个不同的PSAD阈值（0.1，0.15和0.2）在组间进行了敏感性测试，特异性，阳性预测值(PPV)和阴性预测值(NPV)。卡方和方差分析用于双变量分析。所有分析均使用R4.3(R核心团队，2023年）。
结果：在1913名患者中，883（46.1％）进行了前列腺活检。在第1、2、3和4组中，有62（7％），321（36.4%），404（45.8%），96名(10.9%)患者，分别。PSA中位数为5.6（四分位数范围3.4-8.1），6.2(4.8-9),6.8(5.1-9.7),和9（5.6-13），分别(p<0.01)。中位数PV为42.3（30-62），51（36-77）55.5（38-85.9），和59.3（42-110）毫升，分别(p<0.01)。1-4岁年龄组的中位PSAD无差异（0.1[0.07-0.16]，0.11[0.08-0.18],0.1[0.07-0.19],和0.1[0.07-0.2])，分别（p=0.393）。CsPCa在241例（27.3％）患者中被诊断出，其中10人（16.1%），65（20.2%），121（30%），第1-4组分别为45例（46.7％）（p<0.001）。对于组1-4,预测csPCa的PSADAUC为0.75、0.68、0.71和0.74。在不同年龄组(1-4)测试0.15的PSAD阈值时，PPV与NPV为39.1vs.93.2,33.6vs.87，50.9vs.80.8和66.1vs.分别为64.7。
结论：PSAD预测模型在不同年龄组间相似。在年轻患者中，PSAD具有高NPV但低PPV。随着年龄的增长,观察到相反的趋势，可能是由于较高的疾病患病率。虽然PSAD阈值在老年患者中可能不太有用，以排除更高级别前列腺癌，这些诊断的临床后果需要逐例评估.
