Dr. Siddiqui and Dr. Li on the power of nomograms in prostate cancer detection 

In this video, Rashid Siddiqui, MD, and Eric Li, MD, share the take-home messages from the recent Prostate Cancer and Prostatic Diseases paper, “Optimizing detection of clinically significant prostate cancer through nomograms incorporating MRI, clinical features, and advanced serum biomarkers in biopsy naïve men.” Siddiqui and Li are urology residents at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Transcription:

Siddiqui: Our message is simple. If a physician is seeing somebody with an elevated PSA in the range of 2 to 20 [ng/mL], we recommend doing prostate health index, if available, but they can also do percent-free PSA, as Eric mentioned, which is why we made different iterations. But each of those models actually works really well, and our AUC curves are really strong. One of the advantages of our study is that a lot of the other nomograms that have been published, even with 4k score with MRIs, actually have high sensitivity by 90% or so, but I would say where they don't perform as well as when they look at specificity; it's around 30% or so. In our hands, the sensitivity is still very high, but so is the specificity, which really, I think, is a strength of our nomogram. So if a physician is seeing a new patient who is biopsy naive with a PSA of 2 to 20 [ng/mL] , and they either do percent-free PSA or prostate health index, and then get an MRI, I think they could rely on our numbers and be certain that they can avoid biopsy in at least 40% of men reliably—I think that's the important part—and just follow them over time, at a risk of missing very few clinically meaningful prostate cancers.

Li: I think, overall, nomograms are a really powerful tools just because there are so many different clinical variables that we consider when we talk to patients about whether to proceed with prostate biopsy. The various versions of the nomogram that we developed really just helps clinicians synthesize all that information and come up with a probability of clinically significant or higher grade prostate cancer. This is with the understanding that provider and patient thresholds for biopsy may vary. The answer may not be the same for every patient, but using our tool, you can have a better sense of, what exactly is the probability that we'll find something that we will want to treat?

Siddiqui: At the end of the day, it comes down to shared decision-making, which is a big part of discussing prostate cancer. I think this nomogram will allow us, as Dr. Li mentioned, to guide and counsel patients better and with more certainty, because a lot of times what we see in clinic is that physicians are doing this mental calculation in their head and, when things fall in the gray area, they just kind of leave it in the gray area, and then sometimes patients feel the burden of being in that gray area, and then they just get confused. I think having something more solid and something where they can put in a reliable percentage and probability, would help not just the physicians but also the patients.

This transcription was edited for clarity.