Department of Urology, Stanford University School of Medicine, Stanford, California 94305, USA.
J Urol. 2011 Feb;185(2):483-7. doi: 10.1016/j.juro.2010.09.101. Epub 2010 Dec 17.
The prostate cancer risk calculator from the Prostate Cancer Prevention Trial estimates the risk of positive biopsy and 1 containing high grade disease (Gleason score 7 or greater) based on prostate specific antigen, digital rectal examination, family history, race and prior negative biopsy. Since data used to create the calculator came from an unreferred population that underwent mainly sextant biopsy, to our knowledge its usefulness in the contemporary urology practice is unknown.
We performed the same multivariate logistic regression used to derive the prostate cancer risk calculator in a cohort of men from the Stanford Prostate Needle Biopsy Database who underwent initial prostate needle biopsy using an extended 12-core scheme.
Our predictions of overall prostate cancer risk did not differ significantly from those of the calculator. Prostate specific antigen, abnormal digital rectal examination and family history were independent risk factors. However, our model predicted a much greater risk of high grade disease than the prostate cancer risk calculator. Prostate specific antigen, abnormal digital rectal examination and age were independent risk factors for high grade disease.
The difference between our estimated risk of high grade prostate cancer and that of the prostate cancer risk calculator can be potentially explained by 1) differences between the cohorts (referred vs unreferred) or 2) the difference in grading, ie grading accuracy due to the difference in biopsy schemes or to temporally related grade shifts. Caution should be used when applying the prostate cancer risk calculator to counsel patients referred for suspicion of prostate cancer since it underestimates the risk of high grade disease.
前列腺癌预防试验的前列腺癌风险计算器根据前列腺特异性抗原、直肠指检、家族史、种族和先前的阴性活检结果，估计阳性活检和包含高级别疾病（Gleason 评分 7 或更高）的风险。由于用于创建计算器的数据来自接受主要六分区活检的未转诊人群，据我们所知，其在当代泌尿外科实践中的有用性尚不清楚。
我们在斯坦福前列腺针活检数据库中的一组男性中进行了与前列腺癌风险计算器相同的多变量逻辑回归分析，这些男性接受了扩展的 12 核方案进行初始前列腺针活检。
我们对总体前列腺癌风险的预测与计算器的预测没有显著差异。前列腺特异性抗原、异常直肠指检和家族史是独立的危险因素。然而，我们的模型预测高级别疾病的风险远高于前列腺癌风险计算器。前列腺特异性抗原、异常直肠指检和年龄是高级别疾病的独立危险因素。
我们估计的高级别前列腺癌风险与前列腺癌风险计算器之间的差异可能有以下原因：1）队列之间的差异（转诊与未转诊）或 2）分级差异，即由于活检方案的差异或与时间相关的分级转移导致的分级准确性。在因怀疑前列腺癌而转诊的患者中应用前列腺癌风险计算器进行咨询时应谨慎，因为它低估了高级别疾病的风险。
