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A nomogram for predicting a positive repeat prostate biopsy in patients with a previous negative biopsy session
Ernesto Lopez-Corona1, Makoto Ohori, Peter T Scardino
1Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
The Journal of Urology
|September 23, 2003
Summary
A new nomogram helps predict prostate cancer in patients with initial negative biopsies. This tool integrates multiple risk factors to improve clinical decisions for repeat biopsies.
Area of Science:
- Urology
- Oncology
- Biostatistics
Background:
- Prostate cancer is frequently diagnosed at initial biopsy.
- Identifying high-risk patients with negative initial biopsies is crucial.
- Integrating multiple risk factors improves individual risk prediction.
Purpose of the Study:
- To develop a predictive model for positive prostate cancer biopsy after an initial negative result.
- To integrate multiple clinical and pathological risk factors for improved prediction.
Main Methods:
- A cohort of 343 patients with at least one negative biopsy was studied.
- Data collected included age, family history, PSA levels and slope, digital rectal exam, biopsy history, and precursor lesions.
- Cox regression analysis and nomogram construction were used to identify predictors and assess discrimination (concordance index).
Main Results:
- 20% of patients were diagnosed with cancer upon repeat biopsy.
- Cumulative negative cores, PSA slope, high-grade prostatic intraepithelial neoplasia, and atypical small acinar proliferation were significant predictors.
- The developed nomogram achieved a concordance index of 0.70, outperforming individual factors.
Conclusions:
- A nomogram was developed to predict positive prostate biopsy results following prior negative sessions.
- This tool offers a range of cancer probability estimates.
- The nomogram can enhance clinical judgment in deciding on repeat biopsies.