Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for Advanced Risk Modeling of Prostate Cancer-Patient-tailored Risk Stratification Can Reduce Unnecessary Biopsies.

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC; Gleason score≥3+4) detection. Decision making based on European Randomised Study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome prostate-specific antigen (PSA) limitations. OBJECTIVE: We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models (RMs) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariate regression analyses were used to determine significant sPC predictors for RM development. The prediction performance was compared with ERSPC-RCs, RCs refitted on our cohort, Prostate Imaging Reporting and Data System (PI-RADS) v1.0, and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics (ROCs). Discrimination and calibration of the RM, as well as net decision and reduction curve analyses were evaluated based on resampling methods. RESULTS AND LIMITATIONS: PSA, prostate volume, digital-rectal examination, and PI-RADS were significant sPC predictors and included in the RMs together with age. The ROC area under the curve of the RM for biopsy-naïve men was comparable with ERSPC-RC3 plus PI-RADSv1.0 (0.83 vs 0.84) but larger compared with ERSPC-RC3 (0.81), refitted RC3 (0.80), and PI-RADS (0.76). For postbiopsy men, the novel RM's discrimination (0.81) was higher, compared with PI-RADS (0.78), ERSPC-RC4 (0.66), refitted RC4 (0.76), and ERSPC-RC4 plus PI-RADSv1.0 (0.78). Both RM benefits exceeded those of ERSPC-RCs and PI-RADS in the decision regarding which patient to receive biopsy and enabled the highest reduction rate of unnecessary biopsies. Limitations include a monocentric design and a lack of PI-RADSv2.0. CONCLUSIONS: The novel RMs, incorporating clinical parameters and PI-RADS, performed significantly better compared with RMs without PI-RADS and provided measurable benefit in making the decision to biopsy men at a suspicion of PC. For biopsy-naïve patients, both our RM and ERSPC-RC3 plus PI-RADSv1.0 exceeded the prediction performance compared with clinical parameters alone. PATIENT SUMMARY: Combined risk models including clinical and imaging parameters predict clinically relevant prostate cancer significantly better than clinical risk calculators and multiparametric magnetic resonance imaging alone. The risk models demonstrate a benefit in making a decision about which patient needs a biopsy and concurrently help avoid unnecessary biopsies.

The relationship between nicotine dependence level and community-acquired pneumonia in young soldiers: a case control study.

OBJECTIVE: Smoking is an important risk factor in the development of community-acquired pneumonia (CAP). This study was designed to investigate the relationship between nicotine dependence level and the development of CAP. MATERIALS AND METHODS: The Fagerstrom test for nicotine dependence (FTND) was performed to measure nicotine dependence level (NDL). Subjects with a Fagerstrom score (FS) of 5 or lower were defined as low dependence level and a FS score of 6 or higher was defined as high dependence level. RESULTS: The risk of pneumonia development was higher in smokers than in nonsmokers (OR=2.19, 95% CI 1.13-4.23). The pneumonia development risk was 1.91 times higher in the low dependence level group compared to nonsmokers (OR=1.91, 95% CI 0.95-3.83). In the high nicotine dependence level group pneumonia risk was 2.93 times higher than in nonsmokers (OR=2.93, 95% CI 1.34-6.36). We also studied the relationship between CAP and the time to the first cigarette of the day. Risk was the lowest in the smoker group of after 60 minutes and risk ratios increased with decreased time. CONCLUSION: In this study, a high nicotine dependence level was found to be a risk factor associated with smoking for CAP development. The time period of the first cigarette after waking up is also important in pneumonia development as well as in the nicotine dependence level.