title: Development and validation of a nomogram predicting the outcome of prostate biopsy based on patient age, digital rectal examination and serum prostate specific antigen.
abstract: OBJECTIVE
  We developed and validated a nomogram which predicts presence of prostate cancer (PCa) on needle biopsy.
  
  
  METHODS
  We used 3 cohorts of men who were evaluated with sextant biopsy of the prostate and whose presenting prostate specific antigen (PSA) was not greater than 50 ng/ml. Data from 4,193 men from Montreal, Canada were used to develop a nomogram based on age, digital rectal examination (DRE) and serum PSA. External validation was performed on 1,762 men from Hamburg, Germany. Data from these men were subsequently used to develop a second nomogram in which percent free PSA (%fPSA) was added as a predictor. External validation was performed using 514 men from Montreal. Both nomograms were based on multivariate logistic regression models. Predictive accuracy was evaluated with areas under the receiver operating characteristic curve and graphically with loess smoothing plots.
  
  
  RESULTS
  PCa was detected in 1,477 (35.2%) men from Montreal, 739 (41.9%) men from Hamburg and 189 (36.8%) men from Montreal. In all models all predictors were significant at 0.05. Using age, DRE and PSA external validation AUC was 0.69. Using age, DRE, PSA and %fPSA external validation AUC was 0.77.
  
  
  CONCLUSIONS
  A nomogram based on age, DRE, PSA and %fPSA can highly accurately predict the outcome of prostate biopsy in men at risk for PCa.
authors.affiliation: Department of Urology, University of Montreal, Montreal, Quebec, Canada. pierre.karakiewicz@umontreal.ca
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Serge
authors.initials: S
authors.lastname: Benayoun
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Luc
authors.initials: L
authors.lastname: Valiquette
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D010173:Palpation / Q000706:statistics & numerical data*; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000473:pathology*; D011792:Quebec; D012007:Rectum; D015203:Reproducibility of Results; D012306:Risk
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen