title: A comparison of 3 on-line nomograms with the detection of primary circulating prostate cells to predict prostate cancer at initial biopsy.
abstract: BACKGROUND
  The use of nomograms which include the PSA may improve the predictive power of obtaining a prostate biopsy (PB) positive for cancer. We compare the use of three on-line nomagrams with the detection of primary malignant circulating prostate cells (CPCs) to predict the results of an initial PB in men with suspicion of prostate cancer.
  
  
  METHODS
  Consecutive men with suspicion of prostate cancer underwent a 12 core TRUS prostate biopsy; age, total serum PSA, percent free PSA, family history, ethnic origin and prostate ultrasound results were used for risk assessment using the online nomograms. Mononuclear cells were obtained by differential gel centrifugation from 8ml of blood and CPCs were identified using double immunomarcation with anti-PSA and anti-P504S. A CPC was defined as a cell expressing PSA and P504S and defined as negative/positive. Biopsies were classified as cancer/no-cancer. Areas under the curve (AUC) for each parameter were calculated and compared and diagnostic yields were calculated.
  
  
  RESULTS
  1,223 men aged>55 years participated, 467 (38.2%) had a biopsy positive for cancer of whom 114/467 (24.4%) complied with the criteria for active observation. Area under the curve analysis showed CPC detection to be superior (p<0.001), avoiding 57% of potential biopsies while missing 4% of clinically significant prostate cancers.
  
  
  CONCLUSIONS
  The CPC detection was superior to the nomograms in predicting the presence of prostate cancer at initial biopsy; its high negative predictive value potentially reduces the number of biopsies while missing few significant cancers, being superior to the nomograms in this aspect. Being a positive/negative test the detection of CPCs avoids defining a cutoff value which may differ between populations.
authors.affiliation: Servicio de Medicina, Hospital de Carabineros de Chile, Santiago, Chile; Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile. Electronic address: nigelpetermurray@gmail.com.
authors.forename: N P
authors.initials: NP
authors.lastname: Murray
authors.affiliation: Servicio de Urología, Hospital de Carabineros de Chile, Santiago, Chile.
authors.forename: C
authors.initials: C
authors.lastname: Fuentealba
authors.affiliation: Servicio de Urología, Hospital DIPRECA, Santiago, Chile; Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
authors.forename: E
authors.initials: E
authors.lastname: Reyes
authors.affiliation: Servicio de Urología, Hospital de Carabineros de Chile, Santiago, Chile.
authors.forename: O
authors.initials: O
authors.lastname: Jacob
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D049451:Nomograms; D009862:Online Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*
keywords: Biopsia prostática; Circulating prostate cells; Cáncer prostático; Células prostáticas circulantes; Nomogramas; Nomograms; Prostate biopsia; Prostate cancer