Discussion
tumor, cancer, prostate, PCa, pre-diagnosed
TUMOR, CANCER, PROSTATE, LYMPHATIC METASTASIS, MINIMAL RESIDUAL DISEASE
With the emergence of different treatments for localized PCa, the preoperative risk stratification of PCa patients is extremely important. BF is an ideal early prognostic PCa predictor after RP. A previous study reported that BF occurred when tumor tissue residue at surgery (i.e., positive margin and/or subclinical lymphatic metastasis) or cancer had disseminated beyond the prostate and outside the surgical field at surgery (i.e., minimal residual disease) Several commonly used multivariate risk tools based on pre-diagnosed PSA, T stage by DRE, and biopsy grading group categories have been used to predict postoperative PSA results We used DCA in both risk prediction models to compare the NBs of “treat none” with “treat all”. “Treat none” refers to RP for localized PCa, while “treat all” refers to neoadjuvant androgen deprivation, extended radical operation, and lymph node dissection. In clinical settings, the risk threshold of “treat all” may be determined after physicians and patients weigh and judge the relative hazards of aggressive treatment regimen and the benefits of determining postoperative BFs. So, there was no one risk threshold in deciding who demanded RP, but a series of risk thresholds. Because of higher adverse-effect profiles and the disputed curative effects of “treat all”, we selected high risk thresholds for our DCA. Our novel MRI model also demonstrated better calibration characteristics and higher NBs when compared with the baseline model. Our DCA data indicated that when index lesion locations on bpMRI were included in the prediction model, it showed better model fitting and a higher predictive accuracy, thereby decreasing unnecessary treatments while increasing BF sensitivity when compared with the baseline model.