Abstract
ABSTRACTBackground Prostate-specific antigen densities have limited success in diagnosing prostate cancer. We emphasise the importance of the peripheral zone when considered with its cellular constituents, the “prostatocrit”.Objective Using zonal volumes and asymmetry of glandular acini, we generate a peripheral zone acinar volume and density. With the ratio to the whole gland, we can better predict high grade and all grade cancer. We can model the gland into its acinar and stromal elements. This new “prostatocrit” model could offer more accurate nomograms for biopsy.Materials and Methods 674 patients underwent TRUS and biopsy. Whole gland and zonal volumes were recorded. We compared ratio and acinar volumes when added to a “clinic” model using traditional PSA density. Univariate logistic regression was used to find significant predictors for all and high grade cancer. Backwards multiple logistic regression was used to generate ROC curves comparing the new model to conventional density and PSA alone.Outcome and results Prediction of all grades of prostate cancer: significant variables revealed four significant “prostatocrit” parameters: log peripheral zone acinar density; peripheral zone acinar volume/whole gland acinar volume; peripheral zone acinar density/whole gland volume; peripheral zone acinar density. Acinar model (AUC 0.774), clinic model (AUC 0.745) (P=0.0105). Prediction of high grade prostate cancer: peripheral zone acinar density (“prostatocrit”) was the only significant density predictor. Acinar model (AUC 0.811), clinic model (AUC 0.769) (P=0.0005).Conclusion There is renewed use for ratio and “prostatocrit” density of the peripheral zone in predicting cancer. This outperforms all traditional density measurements.
Highlights
PSA and derived densities, whole gland density, prostatocrit model AUC 0.811; - Clinic (PSAD) [1, 2] and the transition zone density PSATD [3], have a limited role in diagnosing cancer despite initial optimism
PSA and derived densities, whole gland density, PSAD [1, 2] and the transition zone density PSATD [3], have a limited role in diagnosing cancer despite initial optimism. This is partly due to age related changes [4].We propose a new way of using the zones of the prostate taking into account their absolute volumes and the asymmetry in the amount of glandular acini within each [5,6,7]
The relative contribution of each zone, in terms of both epithelial acinar cells and their PSA production, to the entire gland. This highlights the contribution of the peripheral zone acinar volume (PZav) and its acinar density (PZad)
Summary
PSA and derived densities, whole gland density, PSAD [1, 2] and the transition zone density PSATD [3], have a limited role in diagnosing cancer despite initial optimism This is partly due to age related changes [4].We propose a new way of using the zones of the prostate taking into account their absolute volumes and the asymmetry in the amount of glandular acini within each [5,6,7]. The peripheral zone is an intrinsically more stable entity (in terms of volumes and relative amounts of stroma and acini) This allows an intuitive approach to use volumes with appropriate densities (not the arbitrary divising of entire PSA into the transition zone).
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