Objective: We aimed to build a nomogram allowing to predict the probability of prostate cancer (PC) after an initial 21-core biopsy and with readily available clinical data. Methods: 1,490 screened men who underwent an initial 21-core biopsy protocol were included. A multivariate logistic regression was realized including age, prostate volume, prostate-specific antigen (PSA) level, digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Receiver-operating characteristic estimates were used to quantify accuracy of each model. Results: PC was detected in 41.3% of the patients. Median PSA, age and prostate volume were 6.2 ng/ml (range 0.2-50), 64.6 years (range 33-87) and 40 ml (range 10-270), respectively. Abnormal TRUS findings were detected in 14.7% of patients. Age, PSA level, prostate volume, DRE and TRUS were significantly associated with PC (all p ≤ 0.004) in univariable logistic regression analysis. In multivariate logistic regression analysis, significant associations were found for age, PSA level, prostate volume and DRE. Predictive accuracy estimate of this model was equal to 0.70. TRUS was not an independent predictor of PC. Conclusions: We constructed the first prebiopsy predictive nomogram based on an extended 21-core biopsy procedure with age, PSA level, DRE and prostate volume which are readily available clinical data to urologists.

1.
Jemal A, Siegel R, Ward E, et al: Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-249.
2.
Schroder FH, Hugosson J, Roobol MJ, et al: Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:1320-1328.
3.
Djulbegovic M, Beyth RJ, Neuberger MM, et al: Screening for prostate cancer: systematic review and metaanalysis of randomised controlled trials. BMJ 2010;341:c4543.
4.
Shariat SF, Karakiewicz PI, Suardi N, et al: Comparison of nomograms with other methods for predicting outcomes in prostate cancer: a critical analysis of the literature. Clin Cancer Res 2008;14:4400-4407.
5.
Chun FK, Graefen M, Briganti A, et al: Initial biopsy outcome prediction - head-to-head comparison of a logistic regression-based nomogram versus artificial neural network. Eur Urol 2007;51:1236-1240.
6.
Chun FK, Karakiewicz PI, Briganti A, et al: A critical appraisal of logistic regression-based nomograms, artificial neural networks, classification and regression-tree models, look-up tables and risk-group stratification models for prostate cancer. BJU Int 2007;99:794-800.
7.
Chun FK, Briganti A, Graefen M, et al: Development and external validation of an extended 10-core biopsy nomogram. Eur Urol 2007;52:436-444.
8.
Chun FK, de la Taille A, van Poppel H, et al: Prostate cancer gene 3 (PCA3): development and internal validation of a novel biopsy nomogram. Eur Urol 2009;56:659-667.
9.
Eastham JA, May R, Robertson JL, et al: Development of a nomogram that predicts the probability of a positive prostate biopsy in men with an abnormal digital rectal examination and a prostate-specific antigen between 0 and 4 ng/ml. Urology 1999;54:709-713.
10.
Finne P, Auvinen A, Aro J, et al: Estimation of prostate cancer risk on the basis of total and free prostate-specific antigen, prostate volume and digital rectal examination. Eur Urol 2002;41:619-626.
11.
Garzotto M, Hudson RG, Peters L, et al: Predictive modeling for the presence of prostate carcinoma using clinical, laboratory, and ultrasound parameters in patients with prostate specific antigen levels < or = 10 ng/ml. Cancer 2003;98:1417-1422.
12.
Karakiewicz PI, Benayoun S, Kattan MW, et al: Development and validation of a nomogram predicting the outcome of prostate biopsy based on patient age, digital rectal examination and serum prostate specific antigen. J Urol 2005;173:1930-1934.
13.
Kranse R, Roobol M, Schroder FH: A graphical device to represent the outcomes of a logistic regression analysis. Prostate 2008;68:1674-1680.
14.
Nam RK, Toi A, Klotz LH, et al: Assessing individual risk for prostate cancer. J Clin Oncol 2007;25:3582-3588.
15.
Suzuki H, Komiya A, Kamiya N, et al: Development of a nomogram to predict probability of positive initial prostate biopsy among Japanese patients. Urology 2006;67:131-136.
16.
Yanke BV, Carver BS, Bianco FJ Jr, et al: African-American race is a predictor of prostate cancer detection: incorporation into a pre-biopsy nomogram. BJU Int 2006;98:783-787.
17.
Yanke BV, Gonen M, Scardino PT, et al: Validation of a nomogram for predicting positive repeat biopsy for prostate cancer. J Urol 2005;173:421-424.
18.
Scattoni V, Raber M, Abdollah F, et al: Biopsy schemes with the fewest cores for detecting 95% of the prostate cancers detected by a 24-core biopsy. Eur Urol 2010;57:1-8.
19.
de la Taille A, Antiphon P, Salomon L, et al: Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate. Urology 2003;61:1181-1186.
20.
Singh H, Canto EI, Shariat SF, et al: Improved detection of clinically significant, curable prostate cancer with systematic 12-core biopsy. J Urol 2004;171:1089-1092.
21.
Presti JC Jr, O'Dowd GJ, Miller MC, et al: Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 2003;169:125-129.
22.
Scattoni V, Zlotta A, Montironi R, et al: Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: a critical analysis of the literature. Eur Urol 2007;52:1309-1322.
23.
Mian BM, Naya Y, Okihara K, et al: Predictors of cancer in repeat extended multisite prostate biopsy in men with previous negative extended multisite biopsy. Urology 2002;60:836-840.
24.
Jones JS, Patel A, Schoenfield L, et al: Saturation technique does not improve cancer detection as an initial prostate biopsy strategy. J Urol 2006;175:485-488.
25.
Eichler K, Hempel S, Wilby J, et al: Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review. J Urol 2006;175:1605-1612.
26.
Guichard G, Larre S, Gallina A, et al: Extended 21-sample needle biopsy protocol for diagnosis of prostate cancer in 1000 consecutive patients. Eur Urol 2007;52:430-435.
27.
Gerstenbluth RE, Seftel AD, Hampel N, et al: The accuracy of the increased prostate specific antigen level (greater than or equal to 20 ng/ml) in predicting prostate cancer: is biopsy always required? J Urol 2002;168:1990-1993.
28.
Ohigashi T, Kanao K, Mizuno R, Kikuchi E, Nakashima J, Oya M: Predicting the probability of significant prostate cancer in Japanese men with serum prostate-specific antigen less than 10 ng/ml: development of a novel pre-biopsy nomogram. Int J Urol 2010;17:274-280.
29.
Chun FK, Epstein JI, Ficarra V, et al: Optimizing performance and interpretation of prostate biopsy: a critical analysis of the literature. Eur Urol 2010;58:851-864.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.