As a result of prostate cancer screening programs, approximately 10% of otherwise healthy men will be found to have an elevated prostate-specific antigen (PSA) level and therefore be at risk for harboring prostate cancer. Patients with an elevated PSA level have a wide variation in the risk for having prostate cancer diagnosed by transrectal ultrasound (TRUS)-guided prostate biopsy. To adequately counsel these patients, some form of individualized risk assessment must be given. There are several tables, artificial neural network (ANN) models, and nomograms that are available to stratify an individual patients risk for having prostate cancer diagnosed by a TRUS biopsy, either initially or on subsequent biopsies after a previous negative biopsy. Presently, nomograms are also being developed to predict the risk not only for having prostate cancer but also for clinically significant prostate cancer. The difficulty in calculating this risk for an individual patient is that the multiple competing clinical and pathologic factors have varying degrees of effect on the overall risk. This problem of competing risk factors can be overcome by the use of nomograms or ANNs. This article reviews the available instruments that are available to the urologist to enable prediction of the risk for having prostate cancer diagnosed by TRUS-guided prostate biopsy.
{"title":"Nomograms and instruments for the initial prostate evaluation: the ability to estimate the likelihood of identifying prostate cancer.","authors":"M. Ohori, P. Swindle","doi":"10.1053/SURO.2002.32520","DOIUrl":"https://doi.org/10.1053/SURO.2002.32520","url":null,"abstract":"As a result of prostate cancer screening programs, approximately 10% of otherwise healthy men will be found to have an elevated prostate-specific antigen (PSA) level and therefore be at risk for harboring prostate cancer. Patients with an elevated PSA level have a wide variation in the risk for having prostate cancer diagnosed by transrectal ultrasound (TRUS)-guided prostate biopsy. To adequately counsel these patients, some form of individualized risk assessment must be given. There are several tables, artificial neural network (ANN) models, and nomograms that are available to stratify an individual patients risk for having prostate cancer diagnosed by a TRUS biopsy, either initially or on subsequent biopsies after a previous negative biopsy. Presently, nomograms are also being developed to predict the risk not only for having prostate cancer but also for clinically significant prostate cancer. The difficulty in calculating this risk for an individual patient is that the multiple competing clinical and pathologic factors have varying degrees of effect on the overall risk. This problem of competing risk factors can be overcome by the use of nomograms or ANNs. This article reviews the available instruments that are available to the urologist to enable prediction of the risk for having prostate cancer diagnosed by TRUS-guided prostate biopsy.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 2 1","pages":"116-22"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Many nomograms are currently available for patients' and physicians' use for prediction of pathologic stage based on preoperative parameters, such as prostate-specific antigen (PSA) level, clinical stage (tumor, node, metastasis), and Gleason score from prostate biopsy specimen. Based on the probability of final pathologic stage as well as patient comorbidity and life expectancy, patients and physicians can decide whether definitive local therapy, systemic therapy, or palliative therapy would be most appropriate. Nomograms have also been developed based on preoperative parameters for prediction of biochemical recurrence-free survival outcome following surgery. These nomograms can help patients understand the long-term cancer cure rates after radical prostatectomy.
{"title":"Nomograms for clinically localized prostate cancer. Part I: radical prostatectomy.","authors":"Misop Han, A. Partin","doi":"10.1053/SURO.2002.32493","DOIUrl":"https://doi.org/10.1053/SURO.2002.32493","url":null,"abstract":"Many nomograms are currently available for patients' and physicians' use for prediction of pathologic stage based on preoperative parameters, such as prostate-specific antigen (PSA) level, clinical stage (tumor, node, metastasis), and Gleason score from prostate biopsy specimen. Based on the probability of final pathologic stage as well as patient comorbidity and life expectancy, patients and physicians can decide whether definitive local therapy, systemic therapy, or palliative therapy would be most appropriate. Nomograms have also been developed based on preoperative parameters for prediction of biochemical recurrence-free survival outcome following surgery. These nomograms can help patients understand the long-term cancer cure rates after radical prostatectomy.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 2 1","pages":"123-30"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58397977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Ross, C. Gerigk, M. Gonen, O. Yossepowitch, I. Cagiannos, P. Sogani, P. Scardino, M. Kattan
When applying nomograms to a clinical setting it is essential to know how their predictions compare with clinicians'. Comparisons exist outside of the prostate cancer literature. We reviewed these comparisons and conducted 2 experiments comparing predictions of clinicians with prostate cancer nomograms. By using Medline, we searched studies from January 1966 to July 1999 that compared human predictions with nomogram predictions. Next, we conducted 2 experiments: (1) 17 urologists were presented with 10 case vignettes and asked to predict the 5-year recurrence-free probabilities for each patient; (2) case presentations of 63 prostate cancer patients (including full clinical histories with complete diagnostic data and surgical findings) were made to a group of 25 clinicians who were asked to predict organ-confined disease. We found 22 published studies comparing human experts with nomograms, greater than half (13 of 22) showed the nomogram performing above the level of the human expert. Our first experiment showed urologist modification of 165 nomogram predictions led to a decrease in prediction accuracy (c-index decreased from.67 to.55, P <.05). In our second experiment, clinician predictions of organ-confined disease were comparable to the nomogram (area under the receiver operating characteristic curve [AUC] 0.78 and 0.79, respectively). A mixed-model suggests the nomogram did not augment clinician prediction accuracy (doctor excess error 1.4%, P =.75, 95% confidence interval [CI]: -10.9% to 8.2%). Our data suggest that nomograms do not seem to diminish predictive accuracy and they may be of significant benefit in certain clinical decision making settings.
当将nomograph应用于临床设置时，了解他们的预测与临床医生的预测相比较是至关重要的。比较存在于前列腺癌文献之外。我们回顾了这些比较，并进行了2个实验，比较临床医生对前列腺癌x线图的预测。通过Medline，我们检索了从1966年1月到1999年7月之间比较人类预测和nomogram预测的研究。接下来，我们进行了2项实验:(1)向17名泌尿科医生提供10例病例图，并要求他们预测每位患者5年无复发概率;(2)将63例前列腺癌患者的病例报告(包括完整的临床病史、完整的诊断资料和手术结果)提交给一组25名临床医生，要求他们预测器官局限性疾病。我们发现22项已发表的研究将人类专家与nomogram进行比较，超过一半(22项中的13项)显示nomogram的表现高于人类专家的水平。我们的第一个实验显示，泌尿科医生修改了165个nomogram预测，导致预测准确性下降(c-index从。67年。55, p < 0.05)。在我们的第二个实验中，临床医生对器官局限性疾病的预测与nomogram(受者工作特征曲线下面积[AUC]分别为0.78和0.79)相当。混合模型表明nomogram并没有提高临床医生的预测准确度(医生超额误差1.4%，P =。75、95%置信区间[CI]: -10.9% ~ 8.2%)。我们的数据表明，图似乎不会降低预测的准确性，它们可能在某些临床决策设置显著的好处。
{"title":"Comparisons of nomograms and urologists' predictions in prostate cancer.","authors":"P. Ross, C. Gerigk, M. Gonen, O. Yossepowitch, I. Cagiannos, P. Sogani, P. Scardino, M. Kattan","doi":"10.1053/SURO.2002.32490","DOIUrl":"https://doi.org/10.1053/SURO.2002.32490","url":null,"abstract":"When applying nomograms to a clinical setting it is essential to know how their predictions compare with clinicians'. Comparisons exist outside of the prostate cancer literature. We reviewed these comparisons and conducted 2 experiments comparing predictions of clinicians with prostate cancer nomograms. By using Medline, we searched studies from January 1966 to July 1999 that compared human predictions with nomogram predictions. Next, we conducted 2 experiments: (1) 17 urologists were presented with 10 case vignettes and asked to predict the 5-year recurrence-free probabilities for each patient; (2) case presentations of 63 prostate cancer patients (including full clinical histories with complete diagnostic data and surgical findings) were made to a group of 25 clinicians who were asked to predict organ-confined disease. We found 22 published studies comparing human experts with nomograms, greater than half (13 of 22) showed the nomogram performing above the level of the human expert. Our first experiment showed urologist modification of 165 nomogram predictions led to a decrease in prediction accuracy (c-index decreased from.67 to.55, P <.05). In our second experiment, clinician predictions of organ-confined disease were comparable to the nomogram (area under the receiver operating characteristic curve [AUC] 0.78 and 0.79, respectively). A mixed-model suggests the nomogram did not augment clinician prediction accuracy (doctor excess error 1.4%, P =.75, 95% confidence interval [CI]: -10.9% to 8.2%). Our data suggest that nomograms do not seem to diminish predictive accuracy and they may be of significant benefit in certain clinical decision making settings.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 2 1","pages":"82-8"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prostate cancer can be effectively treated with either external beam radiation techniques or with brachytherapy. This study was designed to address the methodology that is used to assess outcome data in the current radiation literature and to evaluate available nomograms that can be used to predict outcomes. A literature search was performed and 12 articles reviewed. Risk stratification was the most frequently used methodology to analyze data. This method encompasses disease-specific variables: the pretreatment prostate-specific antigen (PSA) value and the Gleason score are classified by using cut points into low, intermediate, and high-risk groups. Another methodology uses nomograms to predict outcome. The nomogram uses continuous values of each variable so that the outcome probability for a specific set of parameters is quite specific. The advantage of nomogram analysis over risk stratification analysis is presented. In conclusion, only 3 reports were identified in the radiation literature that used a nomogram to predict outcome. One of the nomograms is proprietary and difficult to interpret. The other 2 nomograms, 1 for 3-dimensional radiation and the other for brachytherapy, have been incorporated into hand-held devices that can be used at consultation with the patient to discuss outcome probabilities to assist in treatment decisions.
{"title":"Nomograms for clinically localized prostate cancer. Part II: radiation therapy.","authors":"L. Potters","doi":"10.1053/SURO.2002.32494","DOIUrl":"https://doi.org/10.1053/SURO.2002.32494","url":null,"abstract":"Prostate cancer can be effectively treated with either external beam radiation techniques or with brachytherapy. This study was designed to address the methodology that is used to assess outcome data in the current radiation literature and to evaluate available nomograms that can be used to predict outcomes. A literature search was performed and 12 articles reviewed. Risk stratification was the most frequently used methodology to analyze data. This method encompasses disease-specific variables: the pretreatment prostate-specific antigen (PSA) value and the Gleason score are classified by using cut points into low, intermediate, and high-risk groups. Another methodology uses nomograms to predict outcome. The nomogram uses continuous values of each variable so that the outcome probability for a specific set of parameters is quite specific. The advantage of nomogram analysis over risk stratification analysis is presented. In conclusion, only 3 reports were identified in the radiation literature that used a nomogram to predict outcome. One of the nomograms is proprietary and difficult to interpret. The other 2 nomograms, 1 for 3-dimensional radiation and the other for brachytherapy, have been incorporated into hand-held devices that can be used at consultation with the patient to discuss outcome probabilities to assist in treatment decisions.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 2 1","pages":"131-9"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nomograms are valuable tools for estimating the likelihood of cancer being diagnosed, the pathologic features of a localized cancer, and the prognosis of a patient after treatment. Although the available nomograms are reasonably accurate, better predictive factors including additional clinical factors and new molecular analyses are needed to improve the accuracy or predictions. Nomogram performance will also be enhanced with larger datasets of patients and longer follow-up. We review the concepts of risk stratification and the development and use of nomograms as predictive tools.
{"title":"Nomograms as predictive models.","authors":"J. Eastham, M. Kattan, P. Scardino","doi":"10.1053/SURO.2002.32936","DOIUrl":"https://doi.org/10.1053/SURO.2002.32936","url":null,"abstract":"Nomograms are valuable tools for estimating the likelihood of cancer being diagnosed, the pathologic features of a localized cancer, and the prognosis of a patient after treatment. Although the available nomograms are reasonably accurate, better predictive factors including additional clinical factors and new molecular analyses are needed to improve the accuracy or predictions. Nomogram performance will also be enhanced with larger datasets of patients and longer follow-up. We review the concepts of risk stratification and the development and use of nomograms as predictive tools.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 2 1","pages":"108-15"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with newly diagnosed, clinically localized prostate cancer need information concerning long-term outcomes to make informed decisions regarding treatment options. Several nomograms have been developed that can help in this decision process. By using a nomogram originally published in 1998, patients and clinicians can predict the 15-year clinical outcomes in the absence of aggressive treatment based on age and Gleason score at diagnosis. These predictions are based on patients diagnosed and treated before the routine use of PSA that has accelerated the diagnosis of prostate cancer by at least 5 years. Longer follow-up of contemporary patients will determine whether this nomogram remains accurate in the prostate-specific antigen (PSA) era. In view of the lead-time bias resulting from PSA testing, the outcomes of contemporary patients are likely to be better rather than worse than the results shown.
{"title":"Nomograms for clinically localized disease. Part III: watchful waiting.","authors":"E. Schwartz, P. Albertsen","doi":"10.1053/SURO.2002.32495","DOIUrl":"https://doi.org/10.1053/SURO.2002.32495","url":null,"abstract":"Patients with newly diagnosed, clinically localized prostate cancer need information concerning long-term outcomes to make informed decisions regarding treatment options. Several nomograms have been developed that can help in this decision process. By using a nomogram originally published in 1998, patients and clinicians can predict the 15-year clinical outcomes in the absence of aggressive treatment based on age and Gleason score at diagnosis. These predictions are based on patients diagnosed and treated before the routine use of PSA that has accelerated the diagnosis of prostate cancer by at least 5 years. Longer follow-up of contemporary patients will determine whether this nomogram remains accurate in the prostate-specific antigen (PSA) era. In view of the lead-time bias resulting from PSA testing, the outcomes of contemporary patients are likely to be better rather than worse than the results shown.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"11 1","pages":"140-5"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Estimating prognosis with patients with metastatic disease is important for patient counseling, guiding treatment selection, and assessing treatment outcomes. For patients with noncastrate metastatic disease, androgen ablation is considered first-line therapy, with upward of 80% of patients showing clinical benefit. For these patients, information about duration of response to hormones and overall survival is important. Most patients eventually relapse, at which point the mortality from cancer greatly exceeds that from other causes. This article focuses on prognostic models for patients with progressive noncastrate and castrate metastatic prostate cancer.
{"title":"Outcome predictions for patients with metastatic prostate cancer.","authors":"O. Smaletz, H. Scher","doi":"10.1053/SURO.2002.32938","DOIUrl":"https://doi.org/10.1053/SURO.2002.32938","url":null,"abstract":"Estimating prognosis with patients with metastatic disease is important for patient counseling, guiding treatment selection, and assessing treatment outcomes. For patients with noncastrate metastatic disease, androgen ablation is considered first-line therapy, with upward of 80% of patients showing clinical benefit. For these patients, information about duration of response to hormones and overall survival is important. Most patients eventually relapse, at which point the mortality from cancer greatly exceeds that from other causes. This article focuses on prognostic models for patients with progressive noncastrate and castrate metastatic prostate cancer.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 2 1","pages":"155-63"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58399124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The information available on the World Wide Web is vast. Patients are becoming increasingly interested in resources available to them on the Internet for health and medical information. As the percentage of Americans with Internet access grows, health care providers are being asked by their patients to facilitate the search for quality information. This article provides the groundwork for urologists counseling their patients about Web-based information on prostate cancer. Internet sites that provide clear, in-depth information about symptoms and characteristics of prostate cancer, common tests performed, prevention, and treatment options are reviewed. Ten high-quality, patient-friendly Web sites that may be used as a resource for patients and physicians are presented.
{"title":"Web resources for patients with prostate cancer: a starting point.","authors":"Emily R Lipp","doi":"10.1053/SURO.2002.30396","DOIUrl":"https://doi.org/10.1053/SURO.2002.30396","url":null,"abstract":"The information available on the World Wide Web is vast. Patients are becoming increasingly interested in resources available to them on the Internet for health and medical information. As the percentage of Americans with Internet access grows, health care providers are being asked by their patients to facilitate the search for quality information. This article provides the groundwork for urologists counseling their patients about Web-based information on prostate cancer. Internet sites that provide clear, in-depth information about symptoms and characteristics of prostate cancer, common tests performed, prevention, and treatment options are reviewed. Ten high-quality, patient-friendly Web sites that may be used as a resource for patients and physicians are presented.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"47 1","pages":"32-8"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58397701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although there are many treatment options available to patients with localized prostate cancer, it remains unclear which is superior in terms of overall survival. Patients, therefore, consider a number of other less traditional outcomes when choosing therapy for newly diagnosed disease. In particular, because each treatment can have a unique and highly individual impact on various aspects of the patient's health and daily life, there is a need for a patient-oriented approach to outcomes that accounts for both quantity and quality of life after therapy. Although all therapies can result in some degree of sexual, urinary, or bowel dysfunction, the degree of bother patients experience does not always correlate with the objective degree of symptoms present. Providers must, therefore, make the important distinction between function and bother when presenting the risks for each therapy to patients. Patients should also be aware that if they experience particular bother from their sexual or urinary dysfunction, there are therapies available that will improve erectile function or lower urinary tract voiding dysfunction and result in better quality of life. Finally, when discussing the probability of unwanted outcomes, such as urinary, sexual, or bowel dysfunction after treatment for localized prostate cancer, providers should strive to present risks by using a number of different styles, facilitating understanding, and leading to a truly informed decision that best fits the patient's goals.
{"title":"Treatment outcomes in localized prostate cancer: a patient-oriented approach.","authors":"R. Lee, D. Penson","doi":"10.1053/SURO.2002.30400","DOIUrl":"https://doi.org/10.1053/SURO.2002.30400","url":null,"abstract":"Although there are many treatment options available to patients with localized prostate cancer, it remains unclear which is superior in terms of overall survival. Patients, therefore, consider a number of other less traditional outcomes when choosing therapy for newly diagnosed disease. In particular, because each treatment can have a unique and highly individual impact on various aspects of the patient's health and daily life, there is a need for a patient-oriented approach to outcomes that accounts for both quantity and quality of life after therapy. Although all therapies can result in some degree of sexual, urinary, or bowel dysfunction, the degree of bother patients experience does not always correlate with the objective degree of symptoms present. Providers must, therefore, make the important distinction between function and bother when presenting the risks for each therapy to patients. Patients should also be aware that if they experience particular bother from their sexual or urinary dysfunction, there are therapies available that will improve erectile function or lower urinary tract voiding dysfunction and result in better quality of life. Finally, when discussing the probability of unwanted outcomes, such as urinary, sexual, or bowel dysfunction after treatment for localized prostate cancer, providers should strive to present risks by using a number of different styles, facilitating understanding, and leading to a truly informed decision that best fits the patient's goals.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"63-73"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transrectal ultrasound (TRUS) and prostate biopsy have become one of the most common office-based procedures for the practicing urologist. During the past 50 years, the techniques, indications, and pathologic interpretation of prostate biopsies have evolved. The abandonment of blind finger-guided needle biopsies in favor of systematic TRUS-guided biopsies epitomizes much of this change. Similarly, the indications for prostate biopsy have become more refined. In the past, the presence of a prostatic nodule on digital rectal examination (DRE) was the primary indication for biopsy until the introduction of prostatic-specific antigen (PSA) in the 1980s and its widespread use for prostate cancer screening. Abnormalities of PSA or its derivatives now represent the most common indication for prostate biopsy. Although TRUS initially began as a tool to direct needles into various locations within the prostate, today a great deal of information can be obtained from prostate ultrasound for the discerning clinician. As such, TRUS-guided biopsy of the prostate has become an important staging and diagnostic tool for the practicing urologist. Here we review the current techniques and indications as well as pertinent pathologic and staging data obtained through TRUS and prostate biopsy.
{"title":"Prostate biopsy techniques and indications: when, where, and how?","authors":"D. Scherr, J. Eastham, M. Ohori, P. Scardino","doi":"10.1053/SURO.2002.30395","DOIUrl":"https://doi.org/10.1053/SURO.2002.30395","url":null,"abstract":"Transrectal ultrasound (TRUS) and prostate biopsy have become one of the most common office-based procedures for the practicing urologist. During the past 50 years, the techniques, indications, and pathologic interpretation of prostate biopsies have evolved. The abandonment of blind finger-guided needle biopsies in favor of systematic TRUS-guided biopsies epitomizes much of this change. Similarly, the indications for prostate biopsy have become more refined. In the past, the presence of a prostatic nodule on digital rectal examination (DRE) was the primary indication for biopsy until the introduction of prostatic-specific antigen (PSA) in the 1980s and its widespread use for prostate cancer screening. Abnormalities of PSA or its derivatives now represent the most common indication for prostate biopsy. Although TRUS initially began as a tool to direct needles into various locations within the prostate, today a great deal of information can be obtained from prostate ultrasound for the discerning clinician. As such, TRUS-guided biopsy of the prostate has become an important staging and diagnostic tool for the practicing urologist. Here we review the current techniques and indications as well as pertinent pathologic and staging data obtained through TRUS and prostate biopsy.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"18-31"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58397634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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