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Volume 15, Issue 1 (January 2013) 15, 129–133; 10.1038/aja.2012.111

A nomogram based on age, prostate-specific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer

Ping Tang1,2, Hui Chen3, Matthew Uhlman4, Yu-Rong Lin2, Xiang-Rong Deng2, Bin Wang2, Wen-Jun Yang2 and Ke-Ji Xie2

1 Postgraduate Institute, Southern Medical University, Guangzhou 510515, China
2 Department of Urology, Guangzhou First Municipal People's Hospital, Guangzhou Medical College, Guangzhou 510180, China
3 Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, China
4 Department of Urology, University of Iowa, Iowa City, IA 52242, USA

Correspondence: Professor KJ Xie, (xiekeji@sina.com)

Received 26 June 2012; Revised 19 July 2012; Accepted 1 September 2012 Advance online publication 10 December 2012


Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) status, % free PSA and transrectal ultrasound (TRUS) findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% (223/535). The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.

Keywords: nomogram; prediction; prostate biopsy; prostate cancer; prostate-specific antigen (PSA); prostate volume (PV); age; digital rectal examination (DRE)

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