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A PSMA PET/CT-based risk model for prediction of concordance between targeted biopsy and combined biopsy in detecting prostate cancer

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

This study is to investigate the diagnostic value of 68Ga-PSMA-11 in improving the concordance between mpMRI-TB and combined biopsy (CB) in detecting PCa.

Methods

115 consecutive men with 68Ga-PSMA-11 PET/CT prior to prostate biopsy were included for analysis. PSMA intensity, quantified as maximum standard uptake value (SUVmax), minimum apparent diffusion coefficient (ADCmin) and other clinical characteristics were evaluated relative to biopsy concordance using univariate and multivariate logistic regression analyses. A prediction model was developed based on the identified parameters, and a dynamic online diagnostic nomogram was constructed, with its discrimination evaluated through the area under the ROC curve (AUC) and consistency assessed using calibration plots. To assess its clinical applicability, a decision curve analysis (DCA) was performed, while internal validation was conducted using bootstrapping methods.

Results

Concordance between mpMRI-TB and CB occurred in 76.5% (88/115) of the patients. Multivariate logistic regression analyses performed that SUVmax (OR= 0.952; 95% CI 0.917–0.988; P= 0.010) and ADCmin (OR= 1.006; 95% CI 1.003–1.010; P= 0.001) were independent risk factors for biopsy concordance. The developed model showed a sensitivity, specificity, accuracy and AUC of 0.67, 0.78, 0.81 and 0.78 in the full sample. The calibration curve demonstrated that the nomogram’s predicted outcomes closely resembled the ideal curve, indicating consistency between predicted and actual outcomes. Furthermore, the decision curve analysis (DCA) highlighted the clinical net benefit achievable across various risk thresholds. These findings were reinforced by internal validation.

Conclusions

The developed prediction model based on SUVmax and ADCmin showed practical value in guiding the optimization of prostate biopsy pattern. Lower SUVmax and Higher ADCmin values are associated with greater confidence in implementing mono-TB and safely avoiding SB, effectively balancing benefits and risks.

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Data availability

The data of PSMA PET/CT were generated at the Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, and other raw data were generated at the Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University. Derived data supporting the findings of this study are available on request.

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Funding

Partial financial support was received from the Sino-German Mobility Programme (M-0670), the Natural Science Foundation of Jiangsu Province (BE2020622)

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Author notes

  1. Chaoli An and Xuefeng Qiu are contribute equally to the manuscript.

Authors and Affiliations

  1. Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

    Chaoli An, Xuefeng Qiu, Beibei Liu & Hongqian Guo

  2. Department of Andrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

    Chaoli An & Xiaozhi Zhao

  3. Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China

    Xiang Song, Yu Yang & Jiaxin Shu

  4. Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

    Yao Fu

  5. Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210003, China

    Feng Wang

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  1. Chaoli An
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Contributions

Chaoli An: Project development, Data management, Manuscript writing. Yao Fu: Administrative, technical and material support. Hongqian Guo: Project development, Manuscript editing. Beibei Liu: Data management. Xuefeng Qiu: Project development, Manuscript editing. Xiang Song: Data management. Jiaxin Shu: Data analysis. Feng Wang: Administrative, technical and material support. Yu Yang: Data analysis. Xiaozhi Zhao: Manuscript editing

Corresponding authors

Correspondence to Feng Wang, Xiaozhi Zhao or Hongqian Guo.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board of Nanjing Drum Tower Hospital, Medical School of Nanjing University (approval 2020-173-02).

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Informed consent was obtained from all individual participants included in the study.

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An, C., Qiu, X., Liu, B. et al. A PSMA PET/CT-based risk model for prediction of concordance between targeted biopsy and combined biopsy in detecting prostate cancer. World J Urol 42, 285 (2024). https://doi.org/10.1007/s00345-024-04947-w

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