Configuration and validation of a novel prostate disease nomogram predicting prostate biopsy outcome: A prospective study correlating clinical indicators among Filipino adult males with elevated PSA level
Michael E. Chua, Patrick P. Tanseco, Jonathan S. Mendoza, Josefino C. Castillo, Marcelino L. Morales Jr, Saturnino L. Luna Jr
1. Institute of Urology, St. Luke's Medical Center-Quezon City and Global City, NCR, Philippines;
2. Department of Preventive and Community Medicine, St. Luke's College of Medicine-WHQM, NCR, Philippines;
3. Department of Urology, National Kidney and Transplant Institute, Quezon City, NCR, Philippines
Abstract: Objective: To configure and validate a novel prostate disease nomogram providing prostate biopsy outcome probabilities from a prospective study correlating clinical indicators and diagnostic parameters among Filipino adult male with elevated serum total prostate specific antigen (PSA) level. Methods: A prospective study of all men with an elevated serum total PSA underwent initial prostate biopsy at a tertiary institution from January 2011 to August 2014. Clinical indicators, diagnostic parameters, which includes PSA level and PSA derivatives, were collected and considered as predictive factors for biopsy outcome. Multiple logistic regression analysis involving a backward elimination selection procedure was used to select independent predictors. A nomogram model was developed based on independent predictors to calculate the probability of the biopsy outcomes. A receiver-operating characteristic (ROC) curve was used to assess the accuracy of the nomogram and PSA levels alone in predicting differential biopsy outcome. External validation of the nomogram was performed using separate set of patients' data from another center for determination of sensitivity and specificity. The protocol of this study was reviewed and approved by the Institutional Scientific Review Board (ISRB), Institutional Ethics Review Board (IERB), and registered at Clinicaltrial.gov (Identifier: NCT01826617). Resultsa: A total of 552 patients were referred to our institution for initial prostate biopsy. One hundred and ninety-one (34.6%) patients had benign prostatic hyperplasia, 165 (29.9%) had prostatitis, particularly chronic type. The remaining 196 patients (35.5%) had prostate adenocarcinoma. Number of patients according to Gleason scoring classification of the prostate cancer >8, 7 and 6, were 82 (41.8%), 66 (33.7%), and 48 (24.5%), respectively. The significant independent variables used to predict biopsy outcome were age, family history of prostate cancer, prior prostatitis, PSA level, PSA density, PSA velocity, echogenic findings on ultrasound, and DRE status. The areas under the receiver-operating characteristic curve for prostate cancer using PSA alone and the nomogram were 0.688 and 0.804, respectively. Conclusion: The nomogram configured based on routinely available clinical parameters including PSA derivatives, provides high predictive accuracy with good performance characteristics in predicting the prostate biopsy outcome such as presence of prostate cancer, high Gleason prostate cancer, benign prostatic hyperplasia, and chronic prostatitis.
. [J]. Asian Journal of Urology, 2015, 2(2): 114-122.
Michael E. Chua, Patrick P. Tanseco, Jonathan S. Mendoza, Josefino C. Castillo, Marcelino L. Morales Jr, Saturnino L. Luna Jr. Configuration and validation of a novel prostate disease nomogram predicting prostate biopsy outcome: A prospective study correlating clinical indicators among Filipino adult males with elevated PSA level. Asian Journal of Urology, 2015, 2(2): 114-122.
Barry MJ. Screening for prostate cancer-the controversy that refuses to die. N Engl J Med 2009; 360:1351-4.
[2]
Bangma CH, Roemeling S, Schröder FH. Overdiagnosis and overtreatment of early detected prostate cancer. World J Urol 2007; 25: 3-9.
[3]
Nguyen C, Kattan MW. Formalized prediction of clinically significant prostate cancer: is it possible? Asian J Androl 2012; 14:349-54.
[4]
Abouassaly R, Thompson IM, Plats EA, Klein EA. Epidemiology, etiology, and prevention of prostate cancer. In: Wein AJ, eds. Campbell-Walsh Urology, vol 3, 10th edn. Philadelphia: Saunders, 2012: 2704-25.
[5]
Kamoi K, Babaian RJ. Advances in the application of prostate specific antigen in the detection of early-stage prostate cancer. Semin Oncol1999; 26:140-9.
[6]
Chun FKH, Karakiewicz PI, Briganti A, Walz J, Kattan MW, Huland H, et al. A critical appraisal of logistic regression-based nomogram, artificial neural networks, classifications and regression-tree models, look-up tables and risk-group stratification models for prostate cancer. BJU Int 2007; 99: 794-800.
[7]
Karakiewicz PI, Benayoun S, Kattan MW, Perrotte P, Valiquette L, Scardino PT, 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 2011; 173: 1930-4.
[8]
DeAntoni EP, Crawford ED, Oesterling JE, Ross CA, Berger ER, McLeod DG, et al. Age and race-specific reference ranges for prostate-specific antigen from a large community-based study. Urology 1996;48:234-9.
[9]
Welch HG, Albertsen PC. Prostate cancer diagnosis and treatment after the introduction of prostate specific antigen screening: 1986-2005. J Natl Cancer Inst 2010; 101: 1325-9.
[10]
Wolf AM, Wender RC, Etzioni RB, Thompson IM, D'Amico AV, Volk RJ, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 2010; 60:70-98.
[11]
Loeb S, Carter HB. Early detection, diagnosis, and staging of prostate cancer. In: Wein AJ, eds. Campbell-Walsh Urology, vol 3, 10th edn. Philadelphia: Saunders, 2012: 2764.
[12]
Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 1998; 27:1542-7.
[13]
Shariat SF, Scardino PT, Lilja H. Screening for prostate cancer: an update. Can J Urol 2008;15:4363-74.
[14]
Murray NP, Reyes E, Orellana N, Fuentealba C, Dueñas R. A comparative performance analysis of total PSA, percentage free PSA, PSA velocity, and PSA density versus the detection of primary circulating prostate cells in predicting initial prostate biopsy findings in Chilean men. Biomed Res Int 2014;2014:676572.
[15]
Pitero VG, Bolong DT, Letran JL. Systematic 12-core biopsy protocol versis 6-core biopsy protocol: the value of six additional laterally directed cores in improving prostate cancer detection. Philipp J Urol 2002; 12:1-5.
[16]
Petero VG, Letran JL. Prostate specific antigen density of the transition zone enhances specificity of prostate specific antigen in the detection of prostate cancer in patients with intermediate PSA levels. Philipp J Urol 2003; 13:15-9.
[17]
Saarimäki L, Tammela TL, Määttänen L, Taari K, Kujala PM, Raitanen J, et al. Family history in the finnish prostate cancer screening trial. Int J Cancer 2015;136:2172-7.
[18]
Bascuna R, Luna SL, Serrano DP, Morales ML. Concordance rate of Gleason score between transrectal ultrasound-guided needle biopsy and radical prostatectomy specimens among Filipino men with prostate cancer done in a Tertiary hospital from January 2008-September 2012. St. Luke's J Med. [in press].Abstract presented in USANZ 2013 in Australia.
[19]
Ahn JH, Lee JZ, Chung MK, Ha HK. Nomogram for prediction of prostate cancer with serum prostate specific antigen less than 10 ng/mL. J Korean Med Sci 2014;29:338-42.
[20]
Kawakami S, Numao N, Okubo Y, Koga F, Yamamoto S, Saito K, et al. Development, validation, and head-to-head comparison of logistic regression-based nomograms and artificial neural network models predicting prostate cancer on initial extended biopsy. Eur Urol 2008;54:601-11.
[21]
Jeong IG, Lim JH, Hwang SS, Kim SC, You D, Hong JH, et al. Nomogram using transrectal ultrasound-derived information predicting the detection of high grade prostate cancer on initial biopsy. Prostate Int 2013;1:69-75.
[22]
Park JY, Yoon S, Park MS, Cho DY, Park HS, et al. Initial biopsy outcome prediction in Korean patients-comparison of a noble webbased Korean prostate cancer risk calculator versus prostate-specific antigen testing. J Korean Med Sci 2011; 26: 85-91.
[23]
Tang P, Chen H, Uhlman M, Lin YR, Deng XR, Wang B, et al. A nomogram based on age, prostatespecific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer. Asian J Androl 2013; 15: 129-33.
[24]
Kuo SC, Hung SH, Wang HY, Chien CC, Lu CL, Lin HJ, et al. Chinese nomogram to predict probability of positive initial prostate biopsy: a study in Taiwan region. Asian J Androl 2013;15:780-4.
Christopher Hartman, Nikhil Gupta, David Leavitt, David Hoenig, Zeph Okeke, Arthur Smith. Advances in percutaneous stone surgery[J]. Asian Journal of Urology, 2015, 2(1): 26
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