Nomogram to Predict Insignificant Prostate Cancer at Radical Prostatectomy in Korean Men: A Multi-Center Study.
- Author:
Jae Seung CHUNG
1
;
Han Yong CHOI
;
Hae Ryoung SONG
;
Seok Soo BYUN
;
Seong Il SEO
;
Cheryn SONG
;
Jin Seon CHO
;
Sang Eun LEE
;
Hanjong AHN
;
Eun Sik LEE
;
Tae Kon HWANG
;
Wun Jae KIM
;
Moon Kee CHUNG
;
Tae Young JUNG
;
Ho Song YU
;
Young Deuk CHOI
Author Information
- Publication Type:Original Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
- Keywords: Prostatic neoplasms; nomograms; insignificant
- MeSH: Aged; Asian Continental Ancestry Group; Humans; Logistic Models; Male; Middle Aged; *Nomograms; Prostatectomy; Prostatic Neoplasms/*diagnosis/surgery
- From:Yonsei Medical Journal 2011;52(1):74-80
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: Due to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC. MATERIALS AND METHODS: The study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort. RESULTS: Overall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827. CONCLUSION: Our current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.
