{
  "abstract": "Distinguishing prostate cancer (PCa) from benign prostatic hyperplasia (BPH) in the prostate-specific antigen (PSA) gray zone (4.0-10.0 ng/mL) remains a clinical challenge due to the limited specificity of PSA. While complex radiomics and AI models exist, their high resource requirements limit accessibility. We constructed a diagnostic model to distinguish PCa from BPH in patients with PSA ranging 4.0 to 10.0 ng/mL. This retrospective study recruited consecutive458 participants from January 2017 to September 2019. Eligible patients had PSA levels between 4.0-10.0 ng/mL and underwent prostate biopsy or surgery with histopathological confirmation of PCa or BPH by two independent pathologists. Candidate predictors included age, PSA, free PSA (FPSA), free/total PSA ratio (F/T ratio), prostate volume (PV), PSA density (PSAD), white blood cell count (WBC), neutrophil (NE), lymphocyte (LY), hemoglobin (HB), platelet (PLT), alanine aminotransferase (ALT), aspartate transaminase (AST), total protein (TP), albumin (ALB), globulin (GLB), creatinine (CREA), urea nitrogen (UREA), and phosphorus (PHOS). Multivariable logistic regression was applied to screen independent risk factors, with bootstrap resampling for internal validation. Model discrimination, calibration and clinical net benefit were assessed via receiver operating characteristic (ROC) curves, calibration plots and decision curve analysis (DCA). Among 458 patients (192 with PCa, 266 with BPH), the PCa group had significantly higher PSA, PSAD, AST, TP, ALB, GLB and PHOS, but lower FPSA, F/T ratio and PV (all P<0.05). Age showed marginal significance (P=0.07) and was entered into the regression according to the P<0.1 screening standard. Age, PSA, FPSA, PV, AST, GLB and PHOS were independent PCa predictors. The model's area under the curve (AUC) was 0.834 [95% confidence interval (CI): 0.799-0.867], with optimism-corrected C-index 0.832 (95% CI: 0.796-0.869). Calibration (calibration: 0.92; Hosmer-Lemeshow test P=0.49) and DCA confirmed stable performance and clinical utility. At the Youden-index cutoff of 0.503, sensitivity reached 69.79% (95% CI: 62.7-76.2%), specificity 80.83% (95% CI: 75.5-85.4%). This clinical model shows promise for identifying PCa risk in patients with PSA 4.0-10.0 ng/mL; however, external validation in independent cohorts is needed before clinical implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Clinical Laboratory, Jiangsu Province (Suqian) Hospital, Suqian, China.",
    "Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Bao Xu"
    },
    {
      "affs": [
        1
      ],
      "name": "Jiahong Jiang"
    },
    {
      "affs": [
        1
      ],
      "name": "Litao Zhang"
    },
    {
      "affs": [
        1
      ],
      "name": "Qiuxia Ge"
    },
    {
      "affs": [
        1
      ],
      "name": "Jingping Liu"
    },
    {
      "affs": [
        1
      ],
      "name": "Jun Zhou"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/edva5a1qycc1t.bib",
  "cited_by": 0,
  "doi": "10.21037/tau-2026-0604",
  "fulltext_url": "https://europepmc.org/articles/PMC13741067",
  "id": "edva5a1qycc1t",
  "issns": [
    "2223-4691"
  ],
  "landing_url": "https://europepmc.org/article/MED/42997172",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2748|Prostate Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7223882827",
  "pdf_url": "https://europepmc.org/articles/PMC13741067?pdf=render",
  "pmcid": "PMC13741067",
  "pmid": "42997172",
  "published": "2026-09-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/edva5a1qycc1t.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42997172",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42997172"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2748|Prostate Cancer Diagnosis and Treatment",
      "subfield": "general"
    }
  ],
  "title": "Development and internal validation of a clinical model to increase the diagnostic probability of prostate cancer in patients with prostate-specific antigen levels of 4.0-10.0 ng/mL.",
  "title_text": "Development and internal validation of a clinical model to increase the diagnostic probability of prostate cancer in patients with prostate-specific antigen levels of 4.0-10.0 ng/mL.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/edva5a1qycc1t",
  "venue": "Translational andrology and urology",
  "versions": []
}