Predicting prostate biopsy outcome: artificial neural networks and polychotomous regression are equivalent models.
BACKGROUND
Complex statistical models utilizing multiple inputs to derive a risk assessment may benefit prostate cancer (PC) detection where focus has been on prostate-specific antigen (PSA). This study develops a polychotomous logistic regression (PR) model and an artificial neural network (ANN) for predicting biopsy results, particularly for clinically significant PC.


METHODS
There were 3,025 men undergoing TRUS-guided biopsy (BX) with PSA <10 ng/ml selected. BX outcome classified as benign, atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia (ASAP/PIN), non-significant (NSPC) or clinically significant PC (CSPC). PR and ANN models were developed to distinguish between BX categories. Predictors were age, PSA, abnormal digital rectal examination (DRE), positive transrectal ultrasound (TRUS) and prostate volume.


RESULTS
Among the BXs, 44% were benign, 14% ASAP/PIN, 16% NSPC and 25% CSPC. Median age, PSA and volume were 64 years, 5.7 ng/ml and 50 cc. TRUS lesion was present in 47%, and DRE was abnormal in 39%. PR and ANN models did not differ on percentage BX outcomes correctly predicted (55, 57%, respectively) and were equally poor for both ASAP/PIN (0%) and NSPC (2%). For PR and ANN, 74-78% ASAP/PIN predicted benign, 2% NSPC and 20-24% CSPC. For NSPC, 69-71% predicted benign, 27-29% CSPC. Benign outcomes were well identified (86-88%), although 12-13% classified CSPC. CSPC was correctly identified in 65-66% with misclassifications largely benign (33% for PR and ANN).


CONCLUSIONS
Neither PR nor ANN was able to distinguish between the four biopsy outcomes: ASAP/PIN and NSPC were not distinguished from benign or CSPC. ANN did not perform better than PR. Inclusion of additional predictors may increase the performance of statistical models in predicting BX outcome.
Lawrentschuk
Nathan
N
Department of Urology, University of Toronto, University Health Network, Toronto, ON, Canada. Lawrentschuk@gmail.com
Lockwood
Gina
G
Davies
Peter
P
Evans
Andy
A
Sweet
Joan
J
Toi
Ants
A
Fleshner
Neil E
NE
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016571:Neural Networks, Computer; D009864:Ontario / Q000453:epidemiology; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*
Contemp Clin Trials. 2007 Nov;28(6):763-9
17573244
J Urol. 2007 Feb;177(2):516-20
17222623
J Urol. 2008 Apr;179(4):1321-6
18289581
J Clin Oncol. 2007 Jul 20;25(21):3076-81
17634486
Int Urol Nephrol. 2010 Sep;42(3):667-71
19902377
Am J Surg Pathol. 2006 Sep;30(9):1184-8
16931964
Int Urol Nephrol. 2010 Mar;42(1):29-38
19496018
Urol Oncol. 2008 Sep-Oct;26(5):533-41
18774469
J Urol. 2005 Jun;173(6):1930-4
15879784
Prostate. 2001 Jan 1;46(1):39-44
11170130
J Clin Oncol. 2005 Jul 1;23(19):4322-9
15781880
J Urol. 1994 Nov;152(5 Pt 2):1923-6
7523737
Urology. 1999 Oct;54(4):709-13
10510933
N Engl J Med. 2009 Mar 26;360(13):1310-9
19297565
JAMA. 1997 May 14;277(18):1445-51
9145716
J Natl Cancer Inst. 1998 May 20;90(10):766-71
9605647
Am J Epidemiol. 1986 Jun;123(6):1101-17
3706280
J Urol. 2005 Jan;173(1):70-2
15592031
N Engl J Med. 2009 Mar 26;360(13):1320-8
19297566
J Urol. 2008 Apr;179(4):1332-4
18289588
Clin Cancer Res. 2008 Jul 15;14(14):4400-7
18628454
Nat Clin Pract Urol. 2005 Jun;2(6):262-3
16474814
Int Urol Nephrol. 2010 Sep;42(3):673-81
19902378
J Urol. 2009 Apr;181(4):1628-33; discussion 1633-4
19233388
Mod Pathol. 2006 Feb;19(2):180-5
16341152
Cancer. 2008 Aug 15;113(4):701-9
18553365
J Urol. 2008 Sep;180(3):904-9; discussion 909-10
18635221
J Urol. 2006 Sep;176(3):979-84; discussion 984
16890675
Clin Chem. 2002 Aug;48(8):1279-87
12142385
Cancer. 2008 Oct 15;113(8):2068-72
18792067
J Clin Oncol. 2002 Feb 15;20(4):921-9
11844812
J Urol. 2006 Feb;175(2):505-9
16406982
J Clin Oncol. 2002 Feb 15;20(4):885-7
11844805
Prostate. 1999 Jun 1;39(4):316-22
10344223