Development of Improved Nomogram for Prediction of Outcome of Initial Prostate Biopsy Using Readily Available Clinical Information

doi:10.1016/j.urology.2011.04.042

Urology

Volume 78, Issue 2, August 2011, Pages 392-398

https://doi.org/10.1016/j.urology.2011.04.042 Get rights and content

Objectives

To construct a nomogram that can be used to estimate the risk of prostate cancer (PCa) and high-grade PCa using readily available clinical information for men undergoing initial extended prostate biopsy (PBx). Many nomograms have been developed to predict the outcome of initial PBx. However, most require information not available at the decision to biopsy.

Methods

From March 2000 to April 2010, 1551 men with a prostate-specific antigen (PSA) of ≤10 ng/mL who underwent initial extended PBx were included in the present study. The nomogram predictor variables were patient age, race, prostate-specific antigen (PSA) level, percent free PSA, family history of PCa, and the digital rectal examination findings. The area under the receiver operating characteristic curve was calculated as a measure of discrimination. The calibration was assessed graphically.

Results

Of the 1551 men, 606 (39.1%) had PCa on biopsy. The mean value for age, PSA, and percent free PSA was 63.4 years, 5.1 ng/mL, and 21.4%, respectively. Also, 25.1% and 7.8% of patients with positive PBx findings had digital rectal examination abnormalities and a positive family history, respectively. The univariate and multivariate analyses suggested that all 6 risk factors were predictors of PCa in the study cohort (P < .05). The area under the curve for all factors in a model predicting PCa was 0.73 (95% confidence interval 0.71-0.76). The area under the curve for predicting high-grade PCa was 0.71 (95% confidence interval 0.69-0.74).

Conclusions

The present predictive model allows an assessment of the risk of PCa and high-grade PCa for men undergoing initial extended PBx using readily available, noninvasively obtained clinical data.

Section snippets

Study Population

From March 2000 to April 2010, 1551 patients with the 6 variables under consideration underwent initial transrectal ultrasound-guided ePBx. The patients were from a typical clinical referral practice for PBx performed at all Cleveland Clinic facilities. The indication for PBx was determined by suspicious DRE findings or an elevated PSA level, or both. All men had a PSA level of ≤10 ng/mL. The patients were identified through querying of our institutional review board-approved, Health Insurance

Results

Of a total of 1551 men, 606 (39.1%) had PCa on PBx. The characteristics of the study population are listed in Table 1. The use of univariate and multivariate logistic regression models of analysis suggested that all 6 risk factors were significantly influential (P < .05; Table 2).

Using the total serum PSA level, 1108 patients (71.4%) had a PSA level of 4-10 ng/mL. The AUC of the nomogram was 77% and 72% for patients with a PSA level of <4 and 4-10, respectively (Table 3). Of the 606 men with

Comment

Various efforts have been attempted to develop models that improve the prediction rate of PCa in both initial and repeat PBx settings.¹³ Our nomogram was basically developed using only 6 readily obtainable clinical and laboratory variables; age, PSA, percent free PSA, race, family history of PCa and DRE findings. All these factors can be noninvasively assessed at the initial evaluation. Some models have used transrectal ultrasound findings (eg, prostate volume, PSA density, or hypoechoic areas),

Conclusions

The present predictive model allows an assessment of the risk of PCa and high-grade PCa for men undergoing an initial PBx in an easy and practical method to achieve results with a reasonable accuracy. All the factors that have been used as “input” variables are clinical data readily available when making the decision regarding a urologic referral.

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Furthermore, the prostate cancer detection rate of men with PSA 4–10 ng/ml was 22%–43.5%4,7 in the Western population, which was higher compared to Asian population (9.3–26%).8,9 Nevertheless, variables such as advanced age, race, PSA level, digital rectal examination findings, prostate volume and percent free PSA may improve the positive predictive value of prostate cancer detection in men having PSA between 4.0 and 10.0 ng/ml.10 Present insight from Western and other Asian populations has spurred the interest to study and improve the understanding of prostate cancer detection rates amongst Malaysian men with PSA 4.0–10.0 ng/ml.
To identify the associated factors determining prostate cancer detection using transrectal ultrasound (TRUS)-guided prostate biopsy, within a multi-ethnic Malaysian population with prostate specific antigen (PSA) between 4.0 and 10.0 ng/ml.
Study subjects included men with initial PSA between 4.0 and 10.0 ng/ml that have undergone 12-core TRUS-guided prostate biopsy between 2009 and 2016. The prostate cancer detection rate was calculated, while potential factors associated with detection were investigated via univariable and multivariable analysis.
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Prostate cancer detection in Malaysia is comparatively lower. Our study suggests that ethnicity and PSA density should be considered when recommending first or repeat TRUS-guided prostate biopsy for prostate cancer detection in a multi-ethnic Malaysian population.
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To develop nomograms that predict the probability of overall prostate cancer (PCa) and clinically significant PCa (Gleason ≥7) on magnetic resonance imaging (MRI)-targeted, and combined MRI-targeted and systematic, prostate biopsy.
From June 2012 to August 2014, magnetic resonance imaging to ultrasound fusion-targeted prostate biopsy was performed on 464 men with suspicious regions identified on pre-biopsy 3T MRI along with systematic 12 core biopsy. Logistic regression modeling was used to evaluate predictors of overall and clinically significant PCa, and corresponding nomograms were generated for men who were not previously biopsied or had 1 or more prior negative biopsies. Models were created with 70% of a randomly selected training sample and bias-corrected using bootstrap resampling. The models were then validated with the remaining 30% testing sample pool.
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PSA density, age, and MRI suspicion score predict PCa on combined MRI-targeted and systematic biopsy. Our generated nomograms demonstrate high diagnostic accuracy and may further aid in the decision to perform biopsy in men with clinical suspicion of PCa.
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Age, Prostate Imaging Reporting and Data System (PI-RADS) score, PSA, PSA density, and primary biopsy were predictors of prostate cancer at TPSB on univariable analysis (P<0.0001). PSA showed strong correlation with PSA density and was excluded. The remaining variables were all independent predictors of prostate cancer on multivariable analysis (P<0.0001) and used to generate the nomograms.
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OncologyDevelopment of Improved Nomogram for Prediction of Outcome of Initial Prostate Biopsy Using Readily Available Clinical Information

Objectives

Methods

Results

Conclusions

Section snippets

Study Population

Results

Comment

Conclusions

Eur Urol

J Urol

Urology

Actas Urol Esp

J Urol

Urology

Urology

J Urol

J Urol

J Urol

J Urol

Eur Urol

Prostate specific antigen as a serum marker for adenocarcinoma of the prostate

N Engl J Med

Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen

J Urol

Measurement of prostate specific antigen in serum as a screening test for prostate cancer

N Engl J Med

Oncology
Development of Improved Nomogram for Prediction of Outcome of Initial Prostate Biopsy Using Readily Available Clinical Information