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PCA3‐based nomogram for predicting prostate cancer and high grade cancer on initial transrectal guided biopsy
Author(s) -
Elshafei Ahmed,
Chevli K. Kent,
Moussa Ayman S.,
Kara Onder,
Chueh ShihChieh,
Walter Peter,
Hatem Asmaa,
Gao Tianming,
Jones J. Stephen,
Duff Michael
Publication year - 2015
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.23096
Subject(s) - medicine , prostate cancer , nomogram , biopsy , prostate biopsy , rectal examination , concordance , urology , prostate , prostate specific antigen , pca3 , cancer , gynecology
BACKGROUND To develop a validated prostate cancer antigen 3 (PCA3) based nomogram that predicts likelihood of overall prostate cancer (PCa) and intermediate/high grade prostate cancer (HGPCa) in men pursuing initial transrectal prostate biopsy (TRUS‐PBx). METHODS Data were collected on 3,675 men with serum prostate specific antigen level (PSA) ≤ 20 ng/ml who underwent initial prostate biopsy with at least 10 cores sampling at time of the biopsy. Two logistic regression models were constructed to predict overall PCa and HGPCa incorporating age, race, family history (FH) of PCa, PSA at diagnosis, PCA3, total prostate volume (TPV), and digital rectal exam (DRE). RESULTS One thousand six hundred twenty (44%) patients had biopsy confirmed PCa with 701 men (19.1%) showing HGPCa. Statistically significant predictors of overall PCa were age ( P < 0.0001, OR. 1.51), PSA at diagnosis ( P < 0.0001, OR.1.95), PCA3 ( P < 0.0001, OR.3.06), TPV ( P < 0.0001, OR.0.47), FH ( P = 0.003, OR.1.32), and abnormal DRE ( P = 0.001, OR. 1.32). While for HGPCa, predictors were age ( P < 0.0001, OR.1.77), PSA ( P < 0.0001, OR.2.73), PCA3 ( P < 0.0001, OR.2.26), TPV ( P < 0.0001, OR.0.4), and DRE ( P < 0.0001, OR.1.53). Two nomograms were reconstructed for predicted overall PCa probability at time of initial biopsy with a concordance index of 0.742 (Fig. 1), and HGPCa with a concordance index of 0.768 (Fig. 2). CONCLUSIONS Our internally validated initial biopsy PCA3 based nomogram is reconstructed based on a large dataset. The c‐index indicates high predictive accuracy, especially for high grade PCa and improves the ability to predict biopsy outcomes. Prostate 75:1951–1957, 2015 . © 2015 Wiley Periodicals, Inc.