Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
BJU Int. 2012 May;109(10):1480-8. doi: 10.1111/j.1464-410X.2011.10611.x. Epub 2011 Sep 20.
Study Type - Diagnostic (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? So far, few publications have shown that a prediction model influences the behaviour of both physicians and patients. To our knowledge, it was unknown whether urologists and patients are compliant with the recommendations of a prostate cancer risk calculator and their reasons for non-compliance. Recommendations of the European Randomized study of Screening for Prostate Cancer risk calculator (ERSPC RC) about the need of a prostate biopsy were followed in most patients. In most cases of non-compliance with 'no biopsy' recommendations, a PSA level ≥ 3 ng/mL was decisive to opt for biopsy. Before implementation of the ERSPC RC in urological practices at a large scale, it is important to obtain insight into the use of guidelines that might counteract the adoption of the use of the RC as a result of opposing recommendations.
To assess both urologist and patient compliance with a 'no biopsy' or 'biopsy' recommendation of the European Randomized study of Screening for Prostate Cancer (ERSPC) Risk Calculator (RC), as well as their reasons for non-compliance. To assess determinants of patient compliance.
The ERSPC RC calculates the probability on a positive sextant prostate biopsy (P(posb) ) using serum prostate-specific antigen (PSA) level, outcomes of digital rectal examination and transrectal ultrasonography, and ultrasonographically assessed prostate volume. A biopsy was recommended if P(posb) ≥20%. Between 2008 and 2011, eight urologists from five Dutch hospitals included 443 patients (aged 55-75 years) after a PSA test with no previous biopsy. Urologists calculated the P(posb) using the RC in the presence of patients and completed a questionnaire about compliance. Patients completed a questionnaire about prostate cancer knowledge, attitude towards prostate biopsy, self-rated health (12-Item Short Form Health Survey), anxiety (State Trait Anxiety Inventory-6, Memorial Anxiety Scale for Prostate Cancer) and decision-making measures (Decisional Conflict Scale).
Both urologists and patients complied with the RC recommendation in 368 of 443 (83%) cases. If a biopsy was recommended, almost all patients (96%; 257/269) complied, although 63 of the 174 (36%) patients were biopsied against the recommendation of the RC. Compliers with a 'no biopsy' recommendation had a lower mean P(posb) than non-compliers (9% vs 14%; P < 0.001). Urologists opted for biopsies against the recommendations of the RC because of an elevated PSA level (≥ 3 ng/mL) (78%; 49/63) and patients because they wanted certainty (60%; 38/63).
Recommendations of the ERSPC RC on prostate biopsy were followed in most patients. The RC hence may be a promising tool for supporting clinical decision-making.
研究类型 - 诊断（队列）证据级别 2b 已知的是什么？本研究有何补充？到目前为止，很少有出版物表明预测模型会影响医生和患者的行为。据我们所知，尚不清楚泌尿科医生和患者是否遵守前列腺癌风险计算器的建议，以及他们不遵守的原因。欧洲前列腺癌筛查随机研究风险计算器（ERSPC RC）的建议需要进行前列腺活检，大多数患者都遵循了这一建议。在大多数情况下，不遵守“不进行活检”建议的情况下，PSA 水平≥3ng/ml 是决定进行活检的关键因素。在泌尿外科实践中大规模实施 ERSPC RC 之前，了解可能会阻碍 RC 作为结果的使用的指南的使用是很重要的，因为该计算器的建议存在矛盾。
评估泌尿科医生和患者对欧洲前列腺癌筛查随机研究（ERSPC）风险计算器（RC）的“不进行活检”或“进行活检”建议的依从性，以及他们不遵守的原因。评估患者依从性的决定因素。
ERSPC RC 使用血清前列腺特异性抗原（PSA）水平、数字直肠检查和经直肠超声检查以及经超声评估的前列腺体积计算阳性六分区前列腺活检（P（posb））的概率。如果 P（posb）≥20%，则建议进行活检。2008 年至 2011 年，来自荷兰五家医院的八名泌尿科医生在 PSA 检测后对 443 名（年龄 55-75 岁）无既往活检的患者进行了检测。泌尿科医生在患者在场的情况下使用 RC 计算 P（posb），并填写一份关于依从性的问卷。患者填写了一份关于前列腺癌知识、对前列腺活检的态度、自我评估健康状况（12 项简短健康状况调查问卷）、焦虑（状态特质焦虑量表-6、前列腺癌纪念焦虑量表）和决策措施（决策冲突量表）的问卷。
443 例中有 368 例（83%）患者的泌尿科医生和患者都遵循了 RC 建议。如果建议进行活检，几乎所有患者（96%；257/269）都接受了活检，尽管 RC 推荐的 174 例患者中有 63 例（36%）接受了活检。遵守“不进行活检”建议的患者的平均 P（posb）低于不遵守建议的患者（9%对 14%；P<0.001）。泌尿科医生选择进行活检，违反 RC 建议的原因是 PSA 水平升高（≥3ng/ml）（78%；49/63），患者选择进行活检是因为他们希望获得确定性（60%；38/63）。
大多数患者都遵循了 ERSPC RC 关于前列腺活检的建议。因此，RC 可能是支持临床决策的有前途的工具。
