Department of Urology, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan.
Urology. 2011 Apr;77(4):915-20. doi: 10.1016/j.urology.2010.08.035. Epub 2010 Dec 4.
To develop a nomogram based on a cohort examined with 3-dimensional (3D) protocol for diagnosis of prostate cancer on repeat biopsy.
Of 4074 consecutive men undergoing prostate biopsy at our institutions between 2000 and 2009, 775 men with at least 1 previous negative biopsy underwent repeat biopsy with a 3D protocol. Men with previous atypical glands or atypical small acinar proliferation and/or without available prostate-specific antigen (PSA) kinetics information were excluded. The remaining 515 men constituted the study cohort. We developed a logistic regression-based nomogram with 70% of the cohort selected randomly; we validated it with the remaining 30%. Predictive accuracy and performance characteristics were assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots, respectively. The threshold probability was evaluated with decision curve analysis.
We developed a novel repeat biopsy nomogram incorporating age, free to total PSA ratio, prostate volume, history of previous extended biopsy, and PSA doubling time. Validation confirmed predictive accuracy with an AUC value of 0.791. Calibration plots showed good agreement. The decision curve of the nomogram was superior to the decision curve of biopsying all men in a range of threshold probability over 0.15. At the threshold of 0.2, the number of unnecessary biopsies could be reduced by 10 per 100, without missing prostate cancer.
We developed a novel repeat biopsy nomogram based on a cohort examined with 3D protocol. This repeat biopsy nomogram is clinically beneficial, preventing a substantial number of unnecessary biopsies.
基于使用三维（3D）方案检查的队列，开发一种用于诊断重复前列腺活检中前列腺癌的列线图。
在 2000 年至 2009 年间，我们机构对 4074 例连续男性进行了前列腺活检，其中 775 例至少有 1 次先前阴性活检，使用 3D 方案进行了重复活检。排除了先前有非典型腺体或非典型小腺泡增生和/或没有可用的前列腺特异性抗原（PSA）动力学信息的患者。其余 515 例男性构成了研究队列。我们使用 70%的队列数据随机选择，开发了一个基于逻辑回归的列线图，并使用其余 30%的数据进行验证。使用接受者操作特征曲线（AUC）下的面积和校准图分别评估预测准确性和性能特征。使用决策曲线分析评估阈值概率。
我们开发了一种新的重复活检列线图，纳入了年龄、游离 PSA 与总 PSA 比值、前列腺体积、先前扩展活检史和 PSA 倍增时间。验证确认了 AUC 值为 0.791 的预测准确性。校准图显示出良好的一致性。列线图的决策曲线在阈值概率为 0.15 以上的范围内优于对所有男性进行活检的决策曲线。在阈值为 0.2 时，可以减少每 100 例不必要的活检 10 例，而不会遗漏前列腺癌。
我们基于使用 3D 方案检查的队列，开发了一种新的重复活检列线图。这种重复活检列线图具有临床益处，可以避免大量不必要的活检。
