title: Development of a nomogram for predicting high-grade prostate cancer on biopsy: the significance of serum testosterone levels.
abstract: BACKGROUND
  A screening method that focuses on the early detection of high-grade prostate cancer is required. In this study, two sets of nomograms were developed, one to predict the presence of prostate cancer, and the other to predict the presence of high-grade prostate cancer (defined as Gleason Score > or =7).
  
  
  METHODS
  Prostate biopsies were obtained from 396 men with an abnormal serum level of prostate-specific antigen (PSA). Using factors including age, PSA, follicle stimulating hormone (FSH), serum teststerone level and prostate volume of the transitional zone (TZ), nomograms were created that incorporated these factors. External validations were performed involving 174 males, including 103 normal and 71 prostate cancer cases from our institution.
  
  
  RESULTS
  Out of the 396 patients referred for prostate biopsy, 146 were found to have prostate cancer. On logistic regression analysis, age, PSA, prostate volume of the TZ and FSH were significant predictors of prostate cancer, while serum PSA, and testosterone levels were significant predictors of high-grade prostate cancer. The pretreatment testosterone level was found to be a significant biomarker for predicting the pathological features.
  
  
  CONCLUSIONS
  The testosterone level might be a useful biomarker to be included in conventional PSA screening programs to further improve the efficacy of detecting potentially lethal carcinomas.
authors.affiliation: Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Ide
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Yasuda
authors.forename: Kojiro
authors.initials: K
authors.lastname: Nishio
authors.forename: Keisuke
authors.initials: K
authors.lastname: Saito
authors.forename: Shuji
authors.initials: S
authors.lastname: Isotani
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kamiyama
authors.forename: Satoru
authors.initials: S
authors.lastname: Muto
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horie