Abstract
BackgroundMachine learning has many attractive theoretic properties, specifically, the ability to handle non predefined relations. Additionally, studies have validated the clinical utility of mpMRI for the detection and localization of CSPCa (Gleason score ≥ 3 + 4). In this study, we sought to develop and compare machine-learning models incorporating mpMRI parameters with traditional logistic regression analysis for prediction of PCa (Gleason score ≥ 3 + 3) and CSPCa on initial biopsy.MethodsA total of 688 patients with no prior prostate cancer diagnosis and tPSA ≤ 50 ng/ml, who underwent mpMRI and prostate biopsy were included between 2016 and 2020. We used four supervised machine-learning algorithms in a hypothesis-free manner to build models to predict PCa and CSPCa. The machine-learning models were compared to the logistic regression analysis using AUC, calibration plot, and decision curve analysis.ResultsThe artificial neural network (ANN), support vector machine (SVM), and random forest (RF) yielded similar diagnostic accuracy with logistic regression, while classification and regression tree (CART, AUC = 0.834 and 0.867) had significantly lower diagnostic accuracy than logistic regression (AUC = 0.894 and 0.917) in prediction of PCa and CSPCa (all P < 0.05). However, the CART illustrated best calibration for PCa (SSR = 0.027) and CSPCa (SSR = 0.033). The ANN, SVM, RF, and LR for PCa had higher net benefit than CART across the threshold probabilities above 5%, and the five models for CSPCa displayed similar net benefit across the threshold probabilities below 40%. The RF (53% and 57%, respectively) and SVM (52% and 55%, respectively) for PCa and CSPCa spared more unnecessary biopsies than logistic regression (35% and 47%, respectively) at 95% sensitivity for detection of CSPCa.ConclusionMachine-learning models (SVM and RF) yielded similar diagnostic accuracy and net benefit, while spared more biopsies at 95% sensitivity for detection of CSPCa, compared with logistic regression. However, no method achieved desired performance. All methods should continue to be explored and used in complementary ways.
Highlights
Machine learning has many attractive theoretic properties, the ability to handle non predefined relations
Data collection The clinical variables including the age at prostate biopsy, serum total PSA (tPSA) and free Prostate-specific antigen (PSA) level, reports of multiparametric resonance imaging (mpMRI) examination, and results of prostate biopsy were extracted from clinical records
The mpMRI results were divided into groups according to the reports: “negative”, “equivocal”, and “suspicious” for the presence of Prostate cancer (PCa) (MRI-PCa), seminal vesicle invasion (MRI-Seminal vesicle invasion (SVI)), lymph node invasion (MRI-Lymph node invasion (LNI)) according to the mpMRI reports
Summary
Machine learning has many attractive theoretic properties, the ability to handle non predefined relations. Studies have validated the clinical utility of mpMRI for the detection and localization of CSPCa (Gleason score ≥ 3 + 4). We sought to develop and compare machine-learning models incorporating mpMRI parameters with traditional logistic regression analysis for prediction of PCa (Gleason score ≥ 3 + 3) and CSPCa on initial biopsy. Yu et al BMC Urol (2021) 21:80 insignificant PCa (CSPCa, defined as Gleason score ≥ 3 + 4), and led to an increased number of unnecessary biopsies. This is the case in a PSA gray zone, at which 65–70% of men have a negative biopsy result [3]. To reduce unnecessary biopsy and overdiagnosis, a dozen of nomograms have been used to help diagnose PCa and/or CSPCa, including PCPT-RC [8], STHLM3 [9], ERSPC-RC [10], and CRCC-PC [11], which are based on standard statistical technique of logistic regression (LR)
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