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Recursive partitioning for risk stratification in men undergoing repeat prostate biopsies
Author(s) -
Garzotto Mark,
Park Yon,
MongoueTchokote Solange,
Bledsoe Jesse,
Peters Laura,
Blank Bruce H.,
Austin Donald,
Beer Tomasz M.,
Mori Motomi
Publication year - 2005
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21420
Subject(s) - medicine , risk stratification , recursive partitioning , prostate cancer , prostate , stratification (seeds) , urology , oncology , cancer , seed dormancy , botany , germination , dormancy , biology
BACKGROUND The current study was performed to identify risk factors and risk groups for carcinoma detection in men undergoing repeat prostate biopsies. METHODS The medical records of all men who had a negative initial prostate biopsy and underwent at least one repeat biopsy between 1992 and 2003 were reviewed to extract age, race, family history of prostate carcinoma, body mass index, referral indication, all prostate‐specific antigen (PSA) values, digital rectal examination, PSA density (PSAD), the presence of a hypoechoic lesion, and the presence of high‐grade prostatic intraepithelial neoplasia (HGPIN) on initial biopsy. Risk factors for a subsequent diagnosis of prostate carcinoma were identified using the log‐rank test and a stepwise, stratified Cox regression model. Based on the risk factors identified by Cox regression analysis, recursive partitioning was further used for risk stratification. RESULTS A total of 373 patients underwent 975 biopsy procedures. During a median follow‐up of 37.0 months, prostate carcinoma was detected in 107 of 373 patients (28.9%). Independent predictors of a positive biopsy ( P < 0.05) were PSA doubling time (PSADT), PSAD, referral indication, the presence of HGPIN, patient age, and family history of prostate carcinoma. Recursive partitioning identified 4 distinct risk groups that were characterized by their PSADT and PSAD and the presence of HGPIN and had estimated 2‐year and 5‐year carcinoma detection rates of 3 ± 1% and 21 ± 4%, 28 ± 5% and 40 ± 7%, 22 ± 6% and 58 ± 8%, and 66 ± 9% and 100%, respectively. CONCLUSIONS The authors identified a series of independent risk factors for prostate carcinoma detection after an initial negative prostate biopsy and characterized clinically meaningful and distinct patient risk groups. Despite a negative initial biopsy, patients with high‐risk features remain at risk for the detection of prostate carcinoma. Cancer 2005. Published 2005 by the American Cancer Society.