title: PCA3-based nomogram for predicting prostate cancer and high grade cancer on initial transrectal guided biopsy.
abstract: 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.
authors.affiliation: Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, Ohio.|Urology Department, Al Kasr Al Aini Hospital, Cairo University, Giza, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elshafei
authors.affiliation: NY Department of Urology, Western New York Urology Associates, University at Buffalo School of Medicine and Biomedical Sciences, Cheektowaga, Buffalo, New York.
authors.forename: K Kent
authors.initials: KK
authors.lastname: Chevli
authors.affiliation: Urology Department, Beni Suef University, Beni Suef, Egypt.
authors.forename: Ayman S
authors.initials: AS
authors.lastname: Moussa
authors.affiliation: Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Onder
authors.initials: O
authors.lastname: Kara
authors.affiliation: Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Chueh
authors.affiliation: NY Department of Urology, Western New York Urology Associates, University at Buffalo School of Medicine and Biomedical Sciences, Cheektowaga, Buffalo, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Walter
authors.affiliation: Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Hatem
authors.affiliation: Quantitative Health Sciences Department, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Tianming
authors.initials: T
authors.lastname: Gao
authors.affiliation: Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
authors.affiliation: NY Department of Urology, Western New York Urology Associates, University at Buffalo School of Medicine and Biomedical Sciences, Cheektowaga, Buffalo, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Duff
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000652:urine*; D014408:Biomarkers, Tumor / Q000097:blood / Q000652:urine; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D049451:Nomograms; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000652:urine
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen
keywords: PCA3 nomogram; prostate biopsy; prostate cancer