An artificial neural network considerably improves the diagnostic power of percent free prostate-specific antigen in prostate cancer diagnosis: results of a 5-year investigation.
Our study was performed to evaluate the diagnostic usefulness of %fPSA alone and combined with an ANN at different PSA concentration ranges, including the low range 2-4 ng/ml, to improve the risk assessment of prostate cancer. A total of 928 men with prostate cancer and BPH without any pretreatment of the prostate in the PSA range 2-20 ng/ml were enrolled in the study between 1996 and 2001. An ANN with input data of PSA, %fPSA, patient's age, prostate volume and DRE status was developed to calculate the individual's risk before performing a prostate biopsy within the different PSA ranges 2-4, 4.1-10 and 10.1-20 ng/ml. ROC analysis and cut-off calculations were used to estimate the diagnostic improvement of %fPSA and ANN in comparison to PSA. At the 90% sensitivity level, %fPSA and ANN performed better than PSA in all ranges, enhancing the specificity by 15-28% and 32-44%, respectively. For the low PSA range 2-4 ng/mL, we recommend a first-time biopsy at an ANN specificity level of 90%. For PSA 4-10 ng/mL, we recommend a first-time biopsy based on the ANN at the 90% sensitivity level. Use of an ANN enhances the %fPSA performance to further reduce the number of unnecessary biopsies within the PSA range 2-10 ng/ml.
Stephan
Carsten
C
Department of Urology, University Hospital Charité, Humboldt University, Berlin, Germany.
Jung
Klaus
K
Cammann
Henning
H
Vogel
Birgit
B
Brux
Brigitte
B
Kristiansen
Glen
G
Rudolph
Birgit
B
Hauptmann
Steffen
S
Lein
Michael
M
Schnorr
Dietmar
D
Sinha
Pranav
P
Loening
Stefan A
SA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006801:Humans; D006965:Hyperplasia / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D016571:Neural Networks, Computer; D017430:Prostate-Specific Antigen / Q000096:biosynthesis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013997:Time Factors
D017430:Prostate-Specific Antigen