Open Access Open Badges Research article

A prostate biopsy strategy based on a new clinical nomogram reduces the number of biopsy cores required in high-risk patients

Yuan Huang, Gong Cheng, Bianjiang Liu, Pengfei Shao, Chao Qin, Jie Li, Lixin Hua* and Changjun Yin

Author Affiliations

State Key Laboratory of Reproductive Medicine, Department of Urology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing 210029, China

For all author emails, please log on.

BMC Urology 2014, 14:8  doi:10.1186/1471-2490-14-8

Published: 11 January 2014



The nomograms used for prostate cancer risk assessment in Western countries are not directly applicable to Chinese males; consequently, we have developed a new model to evaluate the risk of them developing this disease.


A total of 1104 patients who had undergone trans-rectal ultrasound (TRUS)-guided 12 + 1-core prostate biopsy were retrospectively evaluated in the first stage of the study. Age, prostate-specific antigen (PSA), the free/total PSA ratio (f/t), digital rectal examination (DRE) findings, the presence of a hypoechoic mass revealed using ultrasound, ultrasonic detection of microcalcifications, prostate volume (PV) and PSA density were considered as predictive factors. Multiple logistic regression analysis involving a backward elimination selection procedure was used to select independent predictors. We compared positive rates regarding 6-core and 12-core biopsy schemes at different risk levels. In the second stage of the study, 238 cases were evaluated using our nomogram. In higher risk patients, we employed a 6 + 1 core biopsy. Positive rates in the first and second stages of the study were compared.


Age, the baseline median natural logarithm of PSA (Ln[PSA]), Ln(PV), f/t, rate of abnormal DRE findings and rate of hypoechoic masses detected using TRUS were the factors that were finally submitted into our nomogram. A significantly greater area under the receiver-operating characteristic curve was obtained for the nomogram than for PSA level alone (0.853 vs. 0.761). A cancer probability cutoff value of 0.5 suggested no significant difference between the 6-core and 12-core biopsy schemes at higher risk levels. In the second stage of the study we verified that in patients with a cancer probability cutoff value >0.5, a 6 + 1-core biopsy could be used without a reduction in the positive detection rate, and significantly reducing the number of biopsy cores required.


A nomogram based on data from Chinese males was developed to predict the positive detection rate, ratio of positive cores and Gleason score at each risk level. According to this nomogram, a reasonable biopsy strategy could be constituted to reduce the number of biopsy cores required in subjects at high risk.

Prostate cancer; Biopsy; Nomogram; Diagnosis