Original Article
Copyright ©2014 Baishideng Publishing Group Co.
World J Clin Urol. Mar 24, 2014; 3(1): 47-53
Published online Mar 24, 2014. doi: 10.5410/wjcu.v3.i1.47
Table 1 Clinical and pathological characteristics n (%)
Predictor variablesNo cancer
Cancer
P value
n = 675n = 132
Digital rectal ex- aminationNegative642 (95.1)122 (92.4)0.209
Positive33 (4.9)10 (7.6)
TRUSNegative603 (89.3)108 (81.8)0.015
Positive72 (10.7)24 (18.2)
HGPIN in previous biopsyNegative648 (96)121 (91.7)0.032
Positive27 (4)11 (8.3)
ASAP in previous biopsyNegative627 (92.9)116 (87.9)0.051
Positive48 (7.1)16 (12.1)
Age, yrMean6768.80.008
SD7.36.3
No. of previous biopsy sessionsMean1.71.70.894
SD11.1
No. of biopsy coresMean11.311.90.006
SD2.42.5
Cumulative No. of coresMean16.115.80.791
SD12.311.4
Months from the initial biopsyMean26.825.70.576
SD21.022.7
Months from the previous biopsyMean16.915.70.353
SD13.713.6
PSA slope (ng/mL per year)Mean1.21.30.824
SD5.713.2
PSA (ng/mL)Mean9.811.60.011
SD6.79.8
Prostate volume (cc)Mean53.043.8< 0.001
SD25.827.2
TZ prostate volume (cc)Mean30.221.2< 0.001
SD20.417.9
PSA density (ng/mL per cc)Mean0.20.3< 0.001
SD0.20.4
PSA TZ density (ng/mL per cc)Mean0.40.8< 0.001
SD0.40.9
Table 2 Association between cancer detection rates and clinical variables according to the number of biopsy sessions
VariableTotal No./No. Ca (%)
Biopsy 2
Biopsy 3
Biopsy 4
Biopsy 5
459/75(16.3)208/34 (16.7)82/15(18)41/3(7)
Digital rectal examination
Negative437/73 (16.7)195/29(14.9)76/12 (15.8)40/3 (7.5)
Positive22/2 (9.1)13/5(38.5)6/3 (50)1/0 (0)
Prostate volume on TRUS, (cc)
Less than 2015/7 (47.7)6/4 (66.7)0/0 (0)0/0 (0)
20-40181/39 (21.5)69/12 (17.4)24/6 (25.0)14/1 (7.1)
40-60145/19 (13.1)75/12 (16.0)35/5 (14.3)16/2 (12.5)
60-8071/7 (9.9)32/6 (18.8)13/2 (15.4)5/0 (0)
80 or Greater47/3 (6.3)26/0 (0)10/2 (20.0)6/0 (0)
PSA density (ng/mL per cc)
Less than 0.15196/16 (8.2)82/11 (13.4)29/6 (20.7)10/0 (0)
0.15-0.30185/33 (17.8)84/10 (11.9)36/6 (16.7)22/3 (13.6)
0.30-0.4546/14 (30.4)20/3 (15.0)10/1 (10.0)7/0 (0)
Greater than 0.4532/12 (38.5)22/10 (45.5)7/2 (28.6)2/0 (0)
PSA TZ density (ng/mL per cc)
Less than 0.25156/9 (5.8)58/7 (12.1)19/3 (18.8)10/0 (0)
0.25-0.5168/22 (13.1)85/11 (12.9)42/7 (16.7)18/2 (22.2)
0.5-1.098/26 (26.5)40/6 (15.0)15/3 (20.0)12/2 (18.3)
Greater than 1.037/18 (48.6)25/10 (40.0)6/2 (33.3)1/0 (0)
PSA (ng/mL)
Less than 418/1 (5.6)1/1 (100)0/0 (0)0/0 (0)
4-10313/48 (15.3)136/19 (14.0)49/8 (16.3)20/2 (10.0)
10-20108/21 (19.4)54/11 (20.3)25/5 (20.0)17/1 (5.9)
Greater than 2020/5 (25.0)17/3 (17.6)8/2 (25.0)4/0 (0)
PSA slope (ng/mL per year)
Less than 0.75237/30 (12.7)102/15 (14.7)44/8 (18.2)21/1 (4.8)
0.75 or greater222/45 (20.3)106/19 (17.9)38/7 (18.4)20/2 (10.0)
Previous HGPIN
Negative437/67 (15.3)200/32 (16.0)79/14 (17.7)40/3 (7.5)
Positive22/8 (36.4)8/2 (25.0)3/1 (33.3)1/0 (0)
Previous ASAP
Negative427/68 (15.9)190/30 (15.8)75/13 (17.3)38/2 (5.3)
Positive32/7 (21.9)18/4 (22.2)7/2 (28.6)3/1 (33.3)
Normal histology406/61 (15.0)184/29 (15.8)72/12 (16.7)37/2 (5.4)
Total459/75 (16.3)208/34 (16.4)82/15 (18.3)41/3 (7.3)
Table 3 Multivariable logistic regression analysis in predicting positive repeat biopsy with generalized estimating equations adjustment for clustering repeat biopsies from the same patients
Predictor variablesQ1Q3Odds ratioLower 0.95Upper 0.95P
Age, yr62731.61.12.50.002
No. of previous biopsy sessions122.30.86.20.002
No. of biopsy cores10121.61.32.10.001
Cumulative No. of cores8200.30.10.80.001
Months from the initial biopsy10.3360.60.22.00.727
Months from the previous biopsy7.122.71.50.63.80.651
PSA slope (ng/mL per year)-0.32.40.90.91.00.007
PSA (ng/mL)611.41.00.34.00.098
Prostate volume (cc)33.560.53.30.520.80.081
TZ prostate volume (cc)1536.10.10.01.00.116
PSA density (ng/mL per cc)0.10.32.50.324.70.045
PSA TZ density (ng/mL per cc)0.20.60.80.16.90.328
DRE-positive: negativeNANA0.70.31.70.393
TRUS-positive: negativeNANA1.40.82.60.218
HGPIN-positive: negativeNANA2.20.95.20.080
ASAP-positive: negativeNANA2.21.14.70.035
Table 4 Published nomograms to predict positive prostate biopsy in repeat biopsy
Ref.No. of patientsAUCAUC of external validationNo of factorsNomogram factorsMean of no of biopsy coresCa detection rate, %
Lopez-Corona et al[9,12]3430.7000.7108Standard factors + PSAV, HGPIN, ASAP, No. of total cores, biopsy history, family history9.1520
2Walz et al[10]1610.720-9Age, PSA, %free PSA, PSA density, TZ density, prostate volume, TZ volume, no of previous biopsy, no of cores.2441
Chun et al[11]10820.7600.68-0.786Standard factors, prostate volume, biopsy history, %free PSA, sampling density11.130.2
Benecchi et al[13]419-0.8567DRE + PSA slope, HGPIN, %free PSA, PSA density-31
Rochester et al[14]1100.8180.6967Standard factors + PSA velocity, HGPIN, biopsy history, %free PSA-30-31
Chun et al[15,16]8090.7000.73-0.7516Standard factors + prostate volume, biopsy history, PCA31539.1
Moussa et al[17]4080.7200.62012Standard factors + prostate volume, PSA velocity, HGPIN, ASAP, No. of total cores, family history, time from initial/previous biopsy, BMI19.131.6
2Sakura et al[18]5150.791-5Age, %free PSA, prostate volume, previous extended biopsy, PSA doubling time2631.6
Present series4590.740-16Age, No. of biopsy core, PSA, PSA density, prostate volume, TZ volume, PSA TZ density, TRUS, DRE, HGPIN, ASAP, months from initial biopsy and previous biopsy, No. of previous negative biopsy, PSA slope11.417