Iseki R, Ohori M, Piccorelli A, Yu C, Piccorelli A, Ohno Y, Tachibana M, Kattan MW. Development of a nomogram for predicting a positive repeat prostate biopsy. World J Clin Urol 2014; 3(1): 47-53 [DOI: 10.5410/wjcu.v3.i1.47]
Corresponding Author of This Article
Ryo Iseki, MD, Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan. iseki@tokyo-med.ac.jp
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Original Article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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 variables
No cancer
Cancer
P value
n = 675
n = 132
Digital rectal ex- amination
Negative
642 (95.1)
122 (92.4)
0.209
Positive
33 (4.9)
10 (7.6)
TRUS
Negative
603 (89.3)
108 (81.8)
0.015
Positive
72 (10.7)
24 (18.2)
HGPIN in previous biopsy
Negative
648 (96)
121 (91.7)
0.032
Positive
27 (4)
11 (8.3)
ASAP in previous biopsy
Negative
627 (92.9)
116 (87.9)
0.051
Positive
48 (7.1)
16 (12.1)
Age, yr
Mean
67
68.8
0.008
SD
7.3
6.3
No. of previous biopsy sessions
Mean
1.7
1.7
0.894
SD
1
1.1
No. of biopsy cores
Mean
11.3
11.9
0.006
SD
2.4
2.5
Cumulative No. of cores
Mean
16.1
15.8
0.791
SD
12.3
11.4
Months from the initial biopsy
Mean
26.8
25.7
0.576
SD
21.0
22.7
Months from the previous biopsy
Mean
16.9
15.7
0.353
SD
13.7
13.6
PSA slope (ng/mL per year)
Mean
1.2
1.3
0.824
SD
5.7
13.2
PSA (ng/mL)
Mean
9.8
11.6
0.011
SD
6.7
9.8
Prostate volume (cc)
Mean
53.0
43.8
< 0.001
SD
25.8
27.2
TZ prostate volume (cc)
Mean
30.2
21.2
< 0.001
SD
20.4
17.9
PSA density (ng/mL per cc)
Mean
0.2
0.3
< 0.001
SD
0.2
0.4
PSA TZ density (ng/mL per cc)
Mean
0.4
0.8
< 0.001
SD
0.4
0.9
Table 2 Association between cancer detection rates and clinical variables according to the number of biopsy sessions
Variable
Total 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
Negative
437/73 (16.7)
195/29(14.9)
76/12 (15.8)
40/3 (7.5)
Positive
22/2 (9.1)
13/5(38.5)
6/3 (50)
1/0 (0)
Prostate volume on TRUS, (cc)
Less than 20
15/7 (47.7)
6/4 (66.7)
0/0 (0)
0/0 (0)
20-40
181/39 (21.5)
69/12 (17.4)
24/6 (25.0)
14/1 (7.1)
40-60
145/19 (13.1)
75/12 (16.0)
35/5 (14.3)
16/2 (12.5)
60-80
71/7 (9.9)
32/6 (18.8)
13/2 (15.4)
5/0 (0)
80 or Greater
47/3 (6.3)
26/0 (0)
10/2 (20.0)
6/0 (0)
PSA density (ng/mL per cc)
Less than 0.15
196/16 (8.2)
82/11 (13.4)
29/6 (20.7)
10/0 (0)
0.15-0.30
185/33 (17.8)
84/10 (11.9)
36/6 (16.7)
22/3 (13.6)
0.30-0.45
46/14 (30.4)
20/3 (15.0)
10/1 (10.0)
7/0 (0)
Greater than 0.45
32/12 (38.5)
22/10 (45.5)
7/2 (28.6)
2/0 (0)
PSA TZ density (ng/mL per cc)
Less than 0.25
156/9 (5.8)
58/7 (12.1)
19/3 (18.8)
10/0 (0)
0.25-0.5
168/22 (13.1)
85/11 (12.9)
42/7 (16.7)
18/2 (22.2)
0.5-1.0
98/26 (26.5)
40/6 (15.0)
15/3 (20.0)
12/2 (18.3)
Greater than 1.0
37/18 (48.6)
25/10 (40.0)
6/2 (33.3)
1/0 (0)
PSA (ng/mL)
Less than 4
18/1 (5.6)
1/1 (100)
0/0 (0)
0/0 (0)
4-10
313/48 (15.3)
136/19 (14.0)
49/8 (16.3)
20/2 (10.0)
10-20
108/21 (19.4)
54/11 (20.3)
25/5 (20.0)
17/1 (5.9)
Greater than 20
20/5 (25.0)
17/3 (17.6)
8/2 (25.0)
4/0 (0)
PSA slope (ng/mL per year)
Less than 0.75
237/30 (12.7)
102/15 (14.7)
44/8 (18.2)
21/1 (4.8)
0.75 or greater
222/45 (20.3)
106/19 (17.9)
38/7 (18.4)
20/2 (10.0)
Previous HGPIN
Negative
437/67 (15.3)
200/32 (16.0)
79/14 (17.7)
40/3 (7.5)
Positive
22/8 (36.4)
8/2 (25.0)
3/1 (33.3)
1/0 (0)
Previous ASAP
Negative
427/68 (15.9)
190/30 (15.8)
75/13 (17.3)
38/2 (5.3)
Positive
32/7 (21.9)
18/4 (22.2)
7/2 (28.6)
3/1 (33.3)
Normal histology
406/61 (15.0)
184/29 (15.8)
72/12 (16.7)
37/2 (5.4)
Total
459/75 (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 variables
Q1
Q3
Odds ratio
Lower 0.95
Upper 0.95
P
Age, yr
62
73
1.6
1.1
2.5
0.002
No. of previous biopsy sessions
1
2
2.3
0.8
6.2
0.002
No. of biopsy cores
10
12
1.6
1.3
2.1
0.001
Cumulative No. of cores
8
20
0.3
0.1
0.8
0.001
Months from the initial biopsy
10.3
36
0.6
0.2
2.0
0.727
Months from the previous biopsy
7.1
22.7
1.5
0.6
3.8
0.651
PSA slope (ng/mL per year)
-0.3
2.4
0.9
0.9
1.0
0.007
PSA (ng/mL)
6
11.4
1.0
0.3
4.0
0.098
Prostate volume (cc)
33.5
60.5
3.3
0.5
20.8
0.081
TZ prostate volume (cc)
15
36.1
0.1
0.0
1.0
0.116
PSA density (ng/mL per cc)
0.1
0.3
2.5
0.3
24.7
0.045
PSA TZ density (ng/mL per cc)
0.2
0.6
0.8
0.1
6.9
0.328
DRE-positive: negative
NA
NA
0.7
0.3
1.7
0.393
TRUS-positive: negative
NA
NA
1.4
0.8
2.6
0.218
HGPIN-positive: negative
NA
NA
2.2
0.9
5.2
0.080
ASAP-positive: negative
NA
NA
2.2
1.1
4.7
0.035
Table 4 Published nomograms to predict positive prostate biopsy in repeat biopsy
Age, 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 slope
11.4
17
Citation: Iseki R, Ohori M, Piccorelli A, Yu C, Piccorelli A, Ohno Y, Tachibana M, Kattan MW. Development of a nomogram for predicting a positive repeat prostate biopsy. World J Clin Urol 2014; 3(1): 47-53