title: Development and external validation of a prostate health index-based nomogram for predicting prostate cancer.
abstract: To develop and externally validate a prostate health index (PHI)-based nomogram for predicting the presence of prostate cancer (PCa) at biopsy in Chinese men with prostate-specific antigen 4-10 ng/mL and normal digital rectal examination (DRE). 347 men were recruited from two hospitals between 2012 and 2014 to develop a PHI-based nomogram to predict PCa. To validate these results, we used a separate cohort of 230 men recruited at another center between 2008 and 2013. Receiver operator curves (ROC) were used to assess the ability to predict PCa. A nomogram was derived from the multivariable logistic regression model and its accuracy was assessed by the area under the ROC (AUC). PHI achieved the highest AUC of 0.839 in the development cohort compared to the other predictors (p < 0.001). Including age and prostate volume, a PHI-based nomogram was constructed and rendered an AUC of 0.877 (95% CI 0.813-0.938). The AUC of the nomogram in the validation cohort was 0.786 (95% CI 0.678-0.894). In clinical effectiveness analyses, the PHI-based nomogram reduced unnecessary biopsies from 42.6% to 27% using a 5% threshold risk of PCa to avoid biopsy with no increase in the number of missed cases relative to conventional biopsy decision.
authors.affiliation: Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Cheng-Tao
authors.initials: CT
authors.lastname: Han
authors.affiliation: Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Gui-Ming
authors.initials: GM
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, P.R. China.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, P.R. China.|Department of Urology, Huashan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
authors.affiliation: State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, P.R. China.|Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, P.R. China.|Department of Urology, Huashan Hospital, Fudan University, Shanghai, P.R. China.|Center for Genetic Epidemiology, School of Life Sciences, Fudan University, Shanghai, P.R. China.
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Xu
authors.affiliation: Department of Surgery, Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Vidal
authors.affiliation: Department of Surgery, Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.affiliation: SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P.R. China.
authors.forename: Chi-Fai
authors.initials: CF
authors.lastname: Ng
authors.affiliation: Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Ding-Wei
authors.initials: DW
authors.lastname: Ye
mesh_terms: D000368:Aged; D019540:Area Under Curve; D044466:Asian People; D002681:China; D015331:Cohort Studies; D051517:Digital Rectal Examination; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D011467:Prostate / Q000502:physiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012372:ROC Curve; D012306:Risk
chemical_list: D017430:Prostate-Specific Antigen