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 doi:

Original Article

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

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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.

Key words： Nomogram Prostate cancer Benign prostatic hyperplasia Prostatitis

Published: 30 April 2015

Corresponding Authors: Michael E. Chua E-mail: auhc_ekim@yahoo.com

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	Marcelino L. Morales Jr
	Saturnino L. Luna Jr

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Michael E. Chua,Patrick P. Tanseco,Jonathan S. Mendoza, et al. 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[J]. Asian Journal of Urology, 2015, 2(2): 114-122.

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http://www.ajurology.com/EN/ OR http://www.ajurology.com/EN/Y2015/V2/I2/114

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