4K density: Adjusting the 4Kscore for prostate volume to improve risk stratification of clinically significant prostate cancer in men undergoing prostate biopsy.

IF 5.8 2区医学 Q1 ONCOLOGY

Prostate Cancer and Prostatic Diseases Pub Date : 2025-10-18 DOI:10.1038/s41391-025-01043-x

Timothy Guerard, Joao G Porto, Thomas Fekete, Omri Nativ, Gareth Reid, Adam Williams, Jonathan Ryan, Kevin Zhou, Elena Cortizas, Pedro Freitas, Archan Khandekar, Bruno Nahar, Chad Ritch, Mark Gonzalgo, Dipen J Parekh, Sanoj Punnen

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引用次数: 0

Abstract

Background: The 4K Score is a blood-based test that estimates the risk of clinically significant prostate cancer (Grade Group ≥2, GG2 + ) by combining four kallikrein markers with clinical variables. However, benign prostatic hyperplasia (BPH) can elevate PSA levels, potentially leading to risk overestimation in men with large prostates. We developed a novel metric, 4K Density (4K Score divided by prostate volume), to adjust for prostate size and improve risk stratification.

Methods: We retrospectively reviewed 3150 men who underwent 4K Score testing at the University of Miami Desai Sethi Urology Institute from 2014 to 2024. After excluding those without a prostate biopsy or MRI within six months of the 4K Score, 1983 men remained. Statistical analysis using SAS v9.4 included logistic regression, receiver operating characteristic (ROC) analysis, and Youden's Index to determine optimal cutoffs for GG2+ detection. The performance of 4K Density was compared to the 4Kscore and PSA Density in predicting GG2+ cancer.

Results: Among the 1983 men, 661 (33%) had GG2+ cancer. 4K Density was significantly higher in men with GG2+ cancer compared to those without (median 0.93 vs. 0.25, p < .0001). In multivariable analysis, 4K Density was the strongest independent predictor (OR 3.51, 95% CI 3.64-4.66), outperforming 4Kscore and PSA density. 4K Density also had the highest AUC (0.81, (95%CI)), compared to 4Kscore (0.76, 95 %CI, <0.0001) and PSA density (0.76, 95% CI, <0.0001). At an optimized cutoff of 0.56, 4K Density achieved 89.9% NPV and 48.5% PPV for detecting GG2+ cancer.

Conclusions: 4K Density is a novel, volume-adjusted biomarker that improves detection of clinically significant prostate cancer and outperforms PSA density and the 4Kscore test. It may be helpful in larger prostates, where confounding from BPH is present. Prospective validation is warranted to confirm its clinical utility.

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4K密度：调整前列腺体积4K评分以改善前列腺活检男性临床显著性前列腺癌的风险分层。

背景：4K评分是一种基于血液的检测，通过将四种钾likrein标记物与临床变量相结合，估计临床显著性前列腺癌（Grade Group≥2,GG2 +）的风险。然而，良性前列腺增生（BPH）可提高PSA水平，可能导致前列腺肥大男性的风险高估。我们开发了一种新的度量标准，4K密度（4K分数除以前列腺体积），以调整前列腺大小并改善风险分层。方法：我们回顾性分析了2014年至2024年在迈阿密大学Desai Sethi泌尿外科研究所接受4K评分测试的3150名男性。在排除那些在4K评分后六个月内没有进行前列腺活检或核磁共振检查的人后，1983名男性仍然存在。使用SAS v9.4进行统计分析，包括逻辑回归、受试者工作特征（ROC）分析和约登指数，以确定GG2+检测的最佳截止点。将4K密度与4Kscore和PSA密度在预测GG2+癌中的表现进行比较。结果：1983例男性中，661例（33%）为GG2+癌。GG2+癌男性的4K密度显著高于无GG2+癌男性（中位数0.93 vs. 0.25, p < 0.0001）。在多变量分析中，4K密度是最强的独立预测因子（OR 3.51, 95% CI 3.64-4.66），优于4K评分和PSA密度。与4Kscore （0.76, 95%CI）相比，4K密度也具有最高的AUC （0.81, 95%CI）。结论：4K密度是一种新型的、可调节体积的生物标志物，可改善临床显著前列腺癌的检测，优于PSA密度和4Kscore测试。它可能对较大的前列腺有帮助，因为前列腺增生存在混淆。有必要进行前瞻性验证以确认其临床应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学

CiteScore

10.00

自引率

6.20%

发文量

142

审稿时长

6-12 weeks

期刊介绍： Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.