title: Assessing individual risk for prostate cancer.
abstract: OBJECTIVE
  To construct a clinical nomogram instrument to estimate individual risk for having prostate cancer (PC) for patients undergoing prostate specific antigen (PSA) screening, using all risk factors known for PC.
  
  
  METHODS
  We conducted a cross-sectional study of 3,108 men who underwent a prostate biopsy, including a subset of 408 volunteers with normal PSA levels. Factors including age, family history of PC (FHPC), ethnicity, urinary symptoms, PSA, free:total PSA ratio, and digital rectal examination (DRE) were incorporated in the model. A nomogram was constructed to assess risk for any and high-grade PC (Gleason score >or= 7).
  
  
  RESULTS
  Of the 3,108 men, 1,304 (42.0%) were found to have PC. Among the 408 men with a normal PSA (< 4.0 ng/mL), 99 (24.3%) had PC. All risk factors were important predictors for PC by multivariate analysis (P, .01 to .0001). The area under the curve (AUC) for the nomogram in predicting cancer, which included age, ethnicity, FHPC, urinary symptoms, free:total PSA ratio, PSA, and DRE, was 0.74 (95% CI, 0.71 to 0.81) and 0.77 (95% CI, 0.74 to 0.81) for high-grade cancer. This was significantly greater than the AUC that considered using the conventional screening method of PSA and DRE only (0.62; 95% CI, 0.58 to 0.66 for any cancer; 0.69; 95% CI, 0.65 to 0.73 for high-grade cancer). From receiver operating characteristic analysis, risk factors including age, ethnicity, FHPC, symptoms, and free:total PSA ratio contributed significantly more predictive information than PSA and DRE.
  
  
  CONCLUSIONS
  In a PC screening program, it is important to consider age, family history of PC, ethnicity, urinary voiding symptoms, and free:total PSA ratio, in addition to PSA and DRE.
authors: Division of Urology, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. robert.nam@utoronto.ca
authors: Robert K
authors: RK
authors: Nam
authors: Ants
authors: A
authors: Toi
authors: Laurence H
authors: LH
authors: Klotz
authors: John
authors: J
authors: Trachtenberg
authors: Michael A S
authors: MA
authors: Jewett
authors: Sree
authors: S
authors: Appu
authors: D Andrew
authors: DA
authors: Loblaw
authors: Linda
authors: L
authors: Sugar
authors: Steven A
authors: SA
authors: Narod
authors: Michael W
authors: MW
authors: Kattan
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D049451:Nomograms; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen