A multicenter retrospective study on evaluation of predicative factors for positive biopsy of prostate cancer in real-world setting

Abstract

Objective

This study aimed to evaluate the predictors for positive biopsy in prostate cancer (PCa) patients and develop a risk-stratification score model for positive biopsy rate in patients with prostate specific antigen (PSA) in the gray zone.

Methods

In this retrospective, multicenter, real-world study, Chinese patients receiving prostate biopsy for the first time were included. The study evaluated the positive biopsy rate, predictors for positive biopsy and a risk prediction model for PSA 4–10 ng/mL PCa was developed. The univariate and multivariate logistic regression analyses were used to identify the risk factors.

Results

A total of 2426 patients were included in the study. The biopsy positive rate was 47.57%, 25.77%, and 60.57% among overall patients, total PSA (t-PSA) 4–10 ng/mL patients, and PSA > 10 ng/mL patients respectively. Elderly age 60–74, ≥75, multi parametric magnetic resonance imaging (MP-MRI), pre-operative PSA > 10 and PSA density (PSAD) significantly increased the positive rate in overall population, and elderly age, MP-MRI, positive digital rectal examination and f-PSA were significant predictors for positive biopsy in PSA 4–10 ng/mL population. A risk prediction model for positive biopsy rate in patients with PSA in the gray zone was developed. Area under curve (AUC) was associated with low accuracy for all the variables used such as tPSA (0.53), PSAD (0.57), frequency of puncture (0.53) and MP-MRI (0.64) in prediction of biopsy positive rate.

Conclusion

Our study evaluated the significant predicative factors for positive biopsy and the PCa risk prediction model developed might help Clinicians to avoid unnecessary biopsy in patients with PSA in gray zone.

Keywords:

• Prostate cancer
• prostate biopsy
• prostate specific antigen
• risk prediction
• MP-MRI

Transparency

Declaration of funding

This paper was funded in part by Astra Zeneca and Tianjin Happy Life Technology Co., Ltd.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors’ contributions

BX, GL, LZ: Study conception and design. BX, LZ, CK, MC, BH, QJ, NL: Analysis and interpretation of the data. BX, LZ, CK, MC, BH, QJ, NL: Drafting of the paper or revising it critically for intellectual content. All the authors read and approved the final version of the manuscript

Acknowledgements

The authors would like to acknowledge Indegene Pvt Ltd, Bangalore, for providing the necessary writing assistance during development of the manuscript which was funded by Astra Zeneca.

This work was supported in data analysis by Tianjin Happy Life Technology Co., Ltd. The authors thank the entire staff of the Department of Urology and Department of Radiology, Peking University First Hospital, Department of urology, Peking University Shougang Hospital, Department of Urology, First Hospital of China Medical University, Department of Urology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Department of Urology, Affiliated Zhongda Hospital of Southeast University.