Accuracy of extraprostatic extension grade combined with PSA and biopsy pathological grouping for diagnosing extracapsular invasion of prostate cancer
Objective:To investigate the accuracy of extraprostatic extension(EPE)grade based on multipara-metric magnetic resonance imaging(mpMRI)combined with prostate-specific antigen(PSA)and biopsy pathologi-cal grouping in diagnosing extracapsular invasion of prostate cancer.Methods:A retrospective analysis of 151 pa-tients who underwent radical prostatectomy at Ningbo Urology &-Nephrology Hospital from October 2021 to A-pril 2023 was performed,including age,PSA,biopsy pathological grouping,and EPE grade based on mpMRI.Five diagnosis schemes were established:①EPE grade alone;②PSA combined with biopsy pathological group-ing;③ EPE grade combined with PSA;④EPE grade combined with biopsy pathological grouping;⑤EPE grade,PSA,and biopsy pathological grouping combined.The results of each diagnosis scheme were compared with post-operative pathological results.The association between each diagnosis scheme and extracapsular invasion of pros-tate cancer was analyzed using binary logistic analysis.Receiver operating characteristic(ROC)curves were plotted for each diagnosis scheme and the area under the curve(AUC)was calculated.The accuracy of each diagnosis scheme was compared through AUC.Decision curve analysis was performed for each diagnosis scheme,and the net benefit was compared among different risk thresholds to analyze the clinical utility of each scheme.Results:In this study,there were 118 cases without extracapsular invasion and 33 cases with extracapsular invasion.Binary logistic analysis showed that EPE grade,PSA,and biopsy pathological grouping were all associated with extracap-sular invasion of prostate cancer(P＜0.05).The AUC values for diagnosing extracapsular invasion using EPE grade alone,EPE grade combined with PSA,EPE grade combined with biopsy pathological grouping,and PSA combined with biopsy pathological grouping were 0.812,0.872,0.853,and 0.766,respectively.The AUC for the combination of EPE grade,PSA,and biopsy pathological grouping was 0.890.Compared with EPE grade a-lone,all combined schemes had higher diagnostic accuracy(P＜0.05),except for PSA combined with biopsy pathological grouping(P=0.440).The accuracy of EPE grade,PSA,and biopsy pathological grouping combined was higher than that of PSA combined with biopsy pathological grouping(P＜0.05),but not significantly differ-ent from EPE grade combined with biopsy pathological grouping or EPE grade combined with PSA(P=0.084,P=0.085).The accuracy of EPE grade combined with PSA grouping was higher than that of PSA combined with biopsy pathological grouping(P=0.014).There was no statistical significance in the differences between EPE grade combined with biopsy pathological grouping and PSA combined with biopsy pathological grouping for extra-capsular invasion(P＞0.05).In most risk threshold regions,except for PSA combined with biopsy pathological grouping,the net benefit of combined diagnosis prediction schemes was higher than that of EPE grade alone,and the highest net benefit was found in the combination of EPE grade,PSA,and biopsy pathological grouping.Con-clusion:All combined schemes have high diagnosis significance for extracapsular invasion of prostate cancer,and the combination of EPE grade,PSA,and biopsy pathological grouping has the highest diagnosis accuracy.
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