Comparison of cancer detection rates by transrectal prostate biopsy for prostate cancer using two different nomograms based on patient’s age and prostate volume
Received 8 November 2018
Accepted for publication 29 January 2019
Published 19 March 2019 Volume 2019:11 Pages 61—68
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Jan Colli
Shunta Hori,1 Nobumichi Tanaka,1 Yasushi Nakai,1 Yosuke Morizawa,1 Yoshihiro Tatsumi,1 Makito Miyake,1 Satoshi Anai,1 Tomomi Fujii,2 Noboru Konishi,2 Yoshinori Nakagawa,3 Syuya Hirao,4 Kiyohide Fujimoto1
1Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; 2Department of Pathology, Nara Medical University, Kashihara, Nara 634-8522, Japan; 3Department of Urology, Yamatotakada Municipal Hospital, Yamatotakada, Nara 635-8501, Japan; 4Department of Urology, Medical Corporation Katsurakai HIRAO Hospital, Kashihara, Nara 634-0076, Japan
Background: The aim of this study is to evaluate the efficacy of two different Nara Urological Research and Treatment Group (NURTG) nomograms allocating 6–12 biopsy cores based on age and prostate volume.
Materials and methods: From April 2006 to July 2014, a total of 1,605 patients who underwent initial prostate biopsy were enrolled. Based on a nomogram taking the patient’s age and prostate volume into consideration, 6–12 biopsy cores were allocated. Two types of nomogram were used, for the former group (before March 2009) and latter group (March 2009 onward). Cancer detection rates in all patients and those with prostate-specific antigen values in the gray zone (4.0–10 ng/mL) were compared. Predictive parameters for detection of prostate cancer in gray-zone patients were also investigated.
Results: The cancer detection rates in all patients and those in the gray zone were 48% and 38% in the former group and 54% and 41% in the latter group, respectively. The cancer detection rate in all patients was significantly higher in the latter group compared with the former group, but detection in gray-zone patients did not show a significant difference between the two groups (P=0.011 and P=0.37, respectively). Multivariate analysis indicated that age, digital rectal examination, prostate volume, transrectal ultrasonography findings, and volume/biopsy ratio were significant predictive parameters in gray-zone patients. The clinically insignificant cancer detection rate was significantly lower in the latter group compared with the former group (P=0.0008).
Conclusion: The latter nomogram provided more acceptable detection rates of clinically significant and insignificant cancer than the former one, and we consider that an initial maximum 12-core transrectal ultrasound-guided needle biopsy may be sufficient for prostate cancer diagnosis.
Keywords: age, cancer detection rate, nomogram, prostate cancer, prostate volume, transrectal prostate biopsy
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