Nomogram using transrectal ultrasound-derived information predicting the detection of high grade prostate cancer on initial biopsy.
OBJECTIVE
To develop a nomogram using transrectal ultrasound (TRUS)-derived information for predicting high grade (HG) prostate cancer (PCa) on initial biopsy.


METHODS
Data were collected on 1,048 men with serum prostate-specific antigen (PSA) levels 4.0 to 9.9 ng/mL who underwent an initial prostate biopsy. Two logistic regression-based nomograms were constructed to predict the detection of PCa. Nomogram-1 incorporated age, digital rectal examination, PSA and percent free PSA data, whereas nomogram-2 incorporated those factors plus TRUS-derived information (i.e., prostate volume and the presence of hypoechoic lesions). The prediction of any PCa and HGPCa (Gleason score≥7) were determined. Twenty percent of the data were randomly reserved for study validation, and the predictive accuracies of the two nomograms were directly compared.


RESULTS
Of the 1,048 men who underwent biopsy, 216 (20.6%) were found to have any PCa, and 97 (9.3%) were found to have HGPCa. All six risk factors were found to be independent predictors for both any PCa and HGPCa. The area under curve (AUC) for nomogram-2 was 0.76 (95% confidence interval [CI], 0.72 to 0.81) for predicting any PCa, and 0.83 (95% CI, 0.79 to 0.88) for predicting HGPCa. These AUCs were greater than those for nomogram-1 (0.72 [95% CI, 0.68 to 0.76 for any PCa; P<0.001], 0.78 [95% CI, 0.72 to 0.83 for HGPCa; P<0.001]). Removing the TRUS-derived information from nomogram-2 resulted in an incremental AUC decrease of 0.052 for any PCa and 0.063 for HGPCa.


CONCLUSIONS
The nomogram using TRUS-derived information had a high predictive accuracy for HGPCa on initial prostate biopsy.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
In Gab
IG
Jeong
Ju Hyun
JH
Lim
Seung-Sik
SS
Hwang
Sung Cheol
SC
Kim
Dalsan
D
You
Jun Hyuk
JH
Hong
Hanjong
H
Ahn
Choung-Soo
CS
Kim
Biopsy; Nomograms; Prostatic neoplasms; Ultrasonography