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Assessing Individual Risk for Prostate Cancer

Robert K. Nam, Ants Toi, Laurence H. Klotz, John Trachtenberg, Michael A.S. Jewett, Sree Appu, D. Andrew Loblaw, Linda Sugar, Steven A. Narod, Michael W. Kattan

From the Division of Urology, Departments of Radiation Oncology and Pathology, Sunnybrook Health Sciences Centre; Division of Urology, Department of Medical Imaging, University Health Network; Department of Public Health Sciences, University of Toronto, Toronto, Canada; and Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH

Address reprint requests to Robert K. Nam, MD, 2075 Bayview Ave, MG-406, Toronto, Ontario, Canada M4N 3M5; e-mail: robert.nam{at}utoronto.ca

Purpose: To construct a clinical nomogram instrument to estimate individual risk for having prostate cancer (PC) for patients undergoing prostate specific antigen (PSA) screening, using all risk factors known for PC.

Patients and Methods: We conducted a cross-sectional study of 3,108 men who underwent a prostate biopsy, including a subset of 408 volunteers with normal PSA levels. Factors including age, family history of PC (FHPC), ethnicity, urinary symptoms, PSA, free:total PSA ratio, and digital rectal examination (DRE) were incorporated in the model. A nomogram was constructed to assess risk for any and high-grade PC (Gleason score 7).

Results: Of the 3,108 men, 1,304 (42.0%) were found to have PC. Among the 408 men with a normal PSA (< 4.0 ng/mL), 99 (24.3%) had PC. All risk factors were important predictors for PC by multivariate analysis (P, .01 to .0001). The area under the curve (AUC) for the nomogram in predicting cancer, which included age, ethnicity, FHPC, urinary symptoms, free:total PSA ratio, PSA, and DRE, was 0.74 (95% CI, 0.71 to 0.81) and 0.77 (95% CI, 0.74 to 0.81) for high-grade cancer. This was significantly greater than the AUC that considered using the conventional screening method of PSA and DRE only (0.62; 95% CI, 0.58 to 0.66 for any cancer; 0.69; 95% CI, 0.65 to 0.73 for high-grade cancer). From receiver operating characteristic analysis, risk factors including age, ethnicity, FHPC, symptoms, and free:total PSA ratio contributed significantly more predictive information than PSA and DRE.

Conclusion: In a PC screening program, it is important to consider age, family history of PC, ethnicity, urinary voiding symptoms, and free:total PSA ratio, in addition to PSA and DRE.

Supported by National Cancer Institute of Canada and the Terry Fox Foundation, Grants No. 010284 and 015164.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Editorial

• Predicting Outcomes in Prostate Cancer: How Many More Nomograms Do We Need?
  Robert W. Ross and Philip W. Kantoff
  JCO 2007 25: 3563-3564 [Full Text]

This article has been cited by other articles:

				R. W. Ross and P. W. Kantoff Predicting Outcomes in Prostate Cancer: How Many More Nomograms Do We Need? J. Clin. Oncol., August 20, 2007; 25(24): 3563 - 3564. [Full Text] [PDF]