Development of a Nomogram Predicting Prostate Cancer Based on Multiparametric Transrectal Ultrasound at the Sextant Level

Abstract

Purpose:

To construct a novel multiparametric transrectal ultrasound (mpTRUS) nomogram integrating conventional ultrasound (US), shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) for prostate cancer (PCa) diagnosis at the sextant level, aiming to improve the diagnostic accuracy and provide a cost-effective alternative to multiparametric magnetic resonance imaging (mpMRI).

Methods:

This prospective study enrolled 187 patients with suspected PCa who underwent mpTRUS followed by TRUS-guided 12-core systematic biopsy. MpTRUS imaging features were analyzed at the sextant level. Independent predictors were identified via univariate and multivariate logistic regression to construct the nomogram. Model performance was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA).

Results:

Multivariate analysis identified hypoechogenicity [odds ratio (OR) = 3.107], asymmetrical SWE distribution (OR = 7.489), nonsynchronous CEUS wash-in (OR = 3.274), heterogeneous CEUS distribution (OR = 2.049), and unequal CEUS enhancement (OR = 2.645) as independent predictors of PCa (all p < 0.001). The mpTRUS nomogram achieved an area under curve (AUC) of 0.891 at the sextant level, outperforming individual modalities. Calibration and DCA confirmed its clinical utility. At the patient level, the average and maximum nomogram scores yielded AUCs of 0.902 and 0.891, respectively, significantly superior to serum prostate-specific antigen.

Conclusion:

This study developed a novel sextant-level mpTRUS nomogram integrating conventional US, SWE, and CEUS, demonstrating high diagnostic accuracy and clinical utility.