OPEN IN READ APP
JOURNAL ARTICLE

The outcomes of transrectal ultrasound guided biopsy of the prostate in a New Zealand population

Andrew R Lienert, Peter J Davidson, J Elisabeth Wells
New Zealand Medical Journal 2009 January 23, 122 (1288): 39-49
19182841

INTRODUCTION: We aim to produce nomograms relating age, digital rectal examinations (DRE), and prostate specific antigen (PSA) to probability of a positive transrectal ultrasound guided (TRUS) prostate biopsy for a New Zealand population. Usefulness of age-adjusted PSA reference ranges and PSA density are also examined.

METHODS: Data was extracted retrospectively from electronic records of prostate biopsies performed between 1995-2007 in Christchurch, New Zealand. Nomograms were created using logistic regression models. The area under the curve (AUC) for age-adjusted PSA ranges, PSA density, and PSA in predicting a positive biopsy was calculated and used to compare these methods.

RESULTS: 4316 biopsies were available for analysis. Data was incomplete for 1177 (27%) of patients. Biopsy was positive in 54.4%. PSA level and DRE finding were strong predictors of a malignant biopsy in our multivariable model but age was not. PSA level and DRE were also predictors of a higher Gleason score (7 or greater). Nomograms are presented relating PSA and DRE to both a positive biopsy result and to biopsy with Gleason score 7 or greater. AUC for age adjusted reference ranges was no better than PSA using a single cutpoint of 4.0. (0.54 vs 0.53). AUC for PSA density using a cutpoint of 0.15 was 0.72. Receiver Operator Characteristic (ROC) curves showed a clear advantage for PSA density over PSA regardless of cutpoint. (AUC 0.80 vs 0.67).

CONCLUSIONS: Nomograms are formulated to help inform New Zealand men how likely they are to have a positive TRUS prostate biopsy and also how likely they are to have a higher grade cancer detected by TRUS prostate biopsy. Age-adjusted reference ranges did not improve prediction of cancer in this population, but the use of PSA density may enhance prostate cancer diagnosis.

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
19182841
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"