Evaluating Possible Predictors of Prostate Cancer to Establish a Scoring System for Repeat Biopsies in Chinese Men

• Published in: Journal of ultrasound in medicine Vol. 30; no. 4; pp. 503 - 508
• Main Authors: Xu, Bin, Min, Zhichao, Cheng, Gong, Mi, Yuanyuan, Tong, Na, Feng, Ninghan, Song, Ninghong, Zhang, Wei, Wu, Hongfei, Zhang, Zhihong, Wang, Zengjun, Hua, Lixin
• Format: Journal Article
• Language: English
• Published: England American Institute of Ultrasound in Medicine 01.04.2011
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Biopsy, Needle; China; Data Interpretation, Statistical; Digital Rectal Examination; Humans; Male; Predictive Value of Tests; prostate cancer; prostate-specific antigen; Prostate-Specific Antigen - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; repeat biopsy; Retreatment; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Ultrasonography, Interventional; volume/biopsy ratio
• ISSN: 0278-4297; 1550-9613
• DOI: 10.7863/jum.2011.30.4.503

Objectives To identify predictors for repeat biopsies in Chinese men with increasing prostate‐specific antigen (PSA) levels or other risk factors for prostate cancer. Methods The study included 129 patients who underwent transrectal sonography–guided repeat biopsies. Potential predictors, including age, body mass index, symptoms, digital rectal examination (DRE), total PSA, free PSA, free/total PSA ratio, prostate volume, PSA density, PSA velocity, PSA doubling time, and volume/biopsy ratio, were subjected to univariate analysis. Multivariate stepwise logistic regression was performed to identify major independent predictors for repeat biopsies, and a scoring system for predicting cancer was devised. A receiver operating characteristic (ROC) curve was constructed to test the sensitivity and specificity of the scoring system. Results Thirty‐four patients (26.36%) had cancer. On univariate analysis, the DRE (P= .002), total PSA (P= .020), free/total PSA ratio (P< .001), prostate volume (P< .001), PSA density (P = .003), and volume/biopsy ratio (P < .001) were significant predictors of cancer. On multivariate analysis, the DRE, total PSA, free/total PSA ratio, and volume/biopsy ratio were independently significant predictors, with odds ratios and 95% confidence intervals of 4.61 (1.62–13.07), 1.02 (1.00–1.04), 0.87 (0.78–0.96), and 0.56 (0.43–0.79). Using ROC analysis, we determined a cutoff value of 2.5 for the scores, at which the sensitivity and specificity of the scoring system for predicting positive repeat biopsy results were 76.50% and 74.70%, with an area under the curve of 0.816 (P < .001). Patients with scores of 3 to 5 had higher cancer detection rates than those with scores of 0 to 2 (52.00% versus 10.13%; P < .001). Conclusions Key predictors may exist to help formulate a scoring system to identify Chinese men who need repeat prostate biopsies. More studies are required to learn its applicability to broader populations.