Improving prostate cancer detection in veterans through the development of a clinical decision rule for prostate biopsy

BMC Urology

Research Article

Thomas J Mason¹  Skai W Schwartz²  Philip R Foulis³  Owen T Hill⁴ 

[1] Department of Environmental and Occupational Health, College of Public Health, University of South Florida, Tampa, FL, USA;Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA;Department of Pathology and Laboratory Medicine, James A. Haley Veteran’s Administration, Tampa, FL, USA;Injury Epidemiology Research Section, Military Performance Division, United States Army Institute of Environmental Medicine, Natick, MA, USA;

关键词: Prostate Cancer;    Prostate Specific Antigen;    Positive Predictive Value;    Prostatitis;    Prostate Biopsy;   

DOI  :  10.1186/1471-2490-13-6

 received in 2012-05-17, accepted in 2012-12-28,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundWe sought to improve prostate cancer (PC) detection through developing a prostate biopsy clinical decision rule (PBCDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after initial PC screening, providing the patient and clinician information to consider prior to biopsy.MethodsThis case–control study evaluated men from the Tampa, Florida, James A. Haley (JH) Veteran’s Administration (VA) (N = 1,378), from January 1, 1998, through April 15, 2005. To assess the PBCDR we did all of the following: 1) Identified biomarkers that are related to PC and have the capability of improving the efficiency of PC screening; 2) Developed statistical models to determine which can best predict the probability of PC; 3) Compared each potential model to PSA alone using Receiver Operator Characteristic (ROC) curves, to evaluate for improved overall effectiveness in PC detection and reduction in (negative) biopsies; and 4) Evaluated dose–response relationships between specified lab biomarkers (surrogates for extra-prostatic disease development) and PC progression.ResultsThe following biomarkers were related to PC: hemoglobin (HGB) (OR = 1.42 95% CI 1.27, 1.59); red blood cell (RBC) count (OR = 2.52 95% CI 1.67, 3.78); PSA (OR = 1.04 95% CI 1.03, 1.05); and, creatinine (OR = 1.55 95% CI 1.12, 2.15). Comparing all PC stages versus non-cancerous conditions, the ROC curve area under the curve (AUC) enlarged (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); PBCDR model 0.68 (95% CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; PBCDR model 61.8%. Comparing PC (stages II, III, IV) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); PBCDR model 0.72 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); PBCDR model 55.3%.ConclusionsThese results suggest evaluating certain common biomarkers in conjunction with PSA may improve PC prediction prior to biopsy. Moreover, these biomarkers may be more helpful in detecting clinically relevant PC. Follow-up studies should begin with replicating the study on different U.S. VA patients involving multiple practices.

【 授权许可】

CC BY   
© Hill et al.; licensee BioMed Central Ltd. 2013