title: An artificial neural network for prostate cancer staging when serum prostate specific antigen is 10 ng./ml. or less.
abstract: OBJECTIVE
  An artificial neural network was developed to improve the prediction of pathological stage before radical prostatectomy based on variables available at biopsy and clinical parameters.
  
  
  METHODS
  We used the prospectively accrued European prostate cancer detection data base to train an artificial neural network to predict pathological stage in 200 men with serum prostate specific antigen (PSA) 10 ng./ml. or less who underwent radical prostatectomy. Variables included in the artificial neural network were patient age, serum PSA, free-to-total PSA ratio, PSA velocity, transrectal ultrasound calculated total and transition zone volumes with their associated PSA parameters (transition zone PSA density and PSA density), digital rectal examination and Gleason score on biopsy. Two multilayer perceptron neural networks were trained on the remaining variables. Data on the 200 patients were divided randomly into a training set, a test set and a validation or prospective set.
  
  
  RESULTS
  Overall classification accuracy of the artificial neural network was 92.7% and 84.2% for organ confined and advanced prostate cancer staging, respectively. For preoperatively predicting local versus advanced stage the area under the ROC curve for the artificial neural network was significantly larger (0.91) compared with logistic regression analysis (0.83), Gleason score (0.69), PSA density (0.68), prostate transition zone volume (0.63) and serum PSA (0.62) (all p <0.01).
  
  
  CONCLUSIONS
  The artificial neural network outperformed logistic regression analysis and correctly predicted pathological stage in more than 90% of the validation patients with serum PSA 10 ng./ml. or less based on clinical, biochemical and biopsy data. In the future artificial neural networks may represent a significant step for improved staging of prostate cancer when counseling patients referred for radical prostatectomy or other curative treatments.
authors.affiliation: Department of Urology, Erasme Hospital, University Clinics of Brussels, Brussels, Belgium.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Zlotta
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Peter B
authors.initials: PB
authors.lastname: Snow
authors.forename: Claude C
authors.initials: CC
authors.lastname: Schulman
authors.forename: Michael
authors.initials: M
authors.lastname: Marberger
authors.forename: Bob
authors.initials: B
authors.lastname: Djavan
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016571:Neural Networks, Computer; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen