A nomogram based on age, prostate-specific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen （PSA）, prostate volume （PV）, digital rectal examination （DRE） status, % free PSA and transrectal ultrasound （TRUS） findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% （223/535）. The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.

Prostate volume as an independent predictor of prostate ：ancer in men with PSA of 10-50 ng ml-1

Prostate volume （PV） has been shown to be associated with prostate cancer （PCa） detection rates in men with a prostate-specific antigen （PSA） in the ＇grey zone＇ （2.0-10.0 ng ml-1）. However, the PSA ＇grey zone＇ in Asian men should be higher because the incidence of PCa in Asian men is relatively low. Therefore, we evaluated the association between PV and PCa detection rates in men with PSAs measuring 10-50 ng ml-1, Men who underwent a 13-core prostatic biopsy with PV documentation participated in the study. A multivariate stepwise regression was used to evaluate whether the PV at time of prostate biopsy could predict the risk of PCa. The rates of PCa among men in different PSA ranges, stratified by PV medians （〈60 and ≥60 ml）, were calculated. There were 261 men included in the final analysis. PV was the strongest predictor of PCa risk （odds ratio, 0.02; P〈0.001） compared to other variables. The PCa rates in men with PVs measuring 〈60 and ≥ 60 ml in the 10-19.9 ng ml-1 PSA group were 40.6% and 15.1%, respectively, while the rates for men with PSAs measuring 20-50 ng ml- 1 were 65.1% and 26.8%. PV is an independent predictor of PCa in men with PSA measuring 10-50 ng ml-1. In clinical practice, particularly for those countries with lower incidences of PCa, PV should be considered when counselling patients with PSAs measuring 10-50 ng ml-1 regarding their PCa risks.

Successful treatment of encrusted cystitis:A case report and review of literature

BACKGROUND Encrusted cystitis(EC)is a chronic inflammation of the bladder associated with mucosal encrustations.Early diagnosis and optimal treatment are not well established.Here,we report a case of EC successfully treated with com-bination therapy.CASE SUMMARY A 27-year-old man presented with frequency,urgency,dysuria,gross hematuria and suprapubic pain for 2 mo.He was diagnosed with EC based on characteristic calcifications of the bladder wall(most of them were struvite),cystoscopy and histopathological examination.He was cured after combined therapy of elimination of encrustations,bladder instillation of hyaluronic acid and injection of botulinum-A neurotoxin into bladder submucosal tissue.CONCLUSION Bladder instillation of hyaluronic acid and injection of botulinum-A neurotoxin into the bladder submucosal tissue can be used for treatment of EC.

PSA density improves the rate of prostate cancer detection in Chinese men with a PSA between 2.5-10.0 ng ml-1 and 10.1-20.0 ng ml-1： a multicenter study

Chinese men should have a higher prostate-specific antigen （PSA） ＂gray zone＂ than the traditional value of 2.5-10.0 ng ml-1 since the incidence of prostate cancer （PCa） in Chinese men is relative low. We hypothesized that PSA density （PSAD） could improve the rate of PCa detection in Chinese men with a PSA higher than the traditional PSA ＂gray zone.＂ A total of 461 men with a PSA between 2.5 and 20.0 ng ml-1, who had undergone prostatic biopsy at two Chinese centers were included in the analysis. The men were then further divided into groups with a PSA between 2.5-10.0 ng ml-1 and 10.1-20.0 ng ml-1. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of PSA and PSAD for the diagnosis of PCa. In men with a PSA of 2.5-10.0 ng ml-1 or 10.1-20.0 ng ml-z, the areas under the ROC curve were higher for PSAD than for PSA. This was consistent across both centers and the cohort overall. When the entire cohort was considered, the optimal PSAD cut-off for predicting PCa in men with a PSA of 2.5-10.0 ng m1-1 was 0.15 ng ml-2 ml-2, with a sensitivity of 64.4% and specificity of 64.6%. The optimal cut-off for PSAD in men with a PSA of 10.1-20.0 ng m1-1 was 0.33 ng ml-1 ml-1, with a sensitivity of 60.3% and specificity of 82.7%. PSAD can improve the effectiveness for PCa detection in Chinese men with a PSA of 2.5-10.0 ng ml-1 （traditional Western PSA ＂gray zone＂） and 10.1-20.0 ng ml-2 （Chinese PSA ＂gray zone＂）.

Free PSA performs better than total PSA in predicting prostate volume in Chinese men with PSA levels of 2.5–9.9 ng ml−1

This study investigated whether free prostate-specific antigen(fPSA)performs better than total PSA(tPSA)in predicting prostate volume(PV)in Chinese men with different PSA levels.A total of 5463 men with PSA levels of<10 ng ml^(−1) and without prostate cancer diagnosis were included in this study.Patients were classified into four groups:PSA<2.5 ng ml^(−1),2.5–3.9 ng ml^(−1),4.0–9.9 ng ml^(−1),and 2.5–9.9 ng ml^(−1).Pearson/Spearman's correlation coefficient(r)and receiver operating characteristic(ROC)curves were used to evaluate the ability of tPSA and fPSA to predict PV.The correlation coefficient between tPSA and PV in the PSA<2.5 ng ml^(−1) cohort(r=0.422;P<0.001)was markedly higher than those of the cohorts with PSA levels of 2.5–3.9 ng ml^(−1),4.0–9.9 ng ml^(−1),and 2.5–9.9 ng ml^(−1)(r=0.114,0.167,and 0.264,respectively;all P≤0.001),while fPSA levels did not differ significantly among different PSA groups.Area under ROC curve(AUC)analyses revealed that the performance of fPSA in predicting PV≥40 ml(AUC:0.694,0.714,and 0.727)was better than that of tPSA(AUC=0.545,0.561,and 0.611)in men with PSA levels of 2.5–3.9 ng ml^(−1),4.0–9.9 ng ml^(−1),and 2.5–9.9 ng ml^(−1),respectively,but not at PSA levels of<2.5 ng ml^(−1)(AUC:0.713 vs 0.720).These findings suggest that the relationship between tPSA and PV may vary with PSA level and that fPSA is more powerful at predicting PV only in the"gray zone"(PSA levels of 2.5–9.9 ng ml^(−1)),but its performance was similar to that of tPSA at PSA levels of<2.5 ng ml^(−1).