Development and internal validation of a prostate health index based nomogram for predicting prostate cancer at extended biopsy

Giovanni Lughezzani, Massimo Lazzeri, Alessandro Larcher, Giuliana Lista, Vincenzo Scattoni, Andrea Cestari, Nicoló Maria Buffi, Vittorio Bini, Giorgio Guazzoni

Research output: Contribution to journalArticlepeer-review


Purpose: We developed and validated a Prostate Health Index (Beckman Coulter, Brea, California) based nomogram to predict prostate cancer at extended prostate biopsy. Materials and Methods: The study population consisted of 729 patients who were scheduled for prostate biopsy following suspicious digital rectal examination and/or increased prostate specific antigen. Total and free prostate specific antigen, percent free-to-total prostate specific antigen, [-2]proPSA and the prostate health index [([-2]proPSA/free prostate specific antigen) × √total prostate specific antigen)] were determined. Logistic regression models were fitted to test prostate cancer predictors. Predictive accuracy estimates of biopsy outcome predictions were quantified. Regression coefficients were used to create a decision making tool to predict prostate cancer. A calibration plot was used to evaluate the extent of overestimating or underestimating the observed prostate cancer rate. Decision curve analysis provided an estimate of the net benefit obtained using the prostate health index based nomogram. Results: Overall 280 of 729 patients (38.4%) were diagnosed with prostate cancer at extended prostate biopsy. On accuracy analyses prostate health index emerged as the most informative predictor of prostate cancer (AUC 0.70) compared to established predictors, such as total prostate specific antigen (0.51) and percent free-to-total prostate specific antigen (0.62). Including the prostate health index in a multivariable logistic regression model based on patient age, prostate volume, digital rectal examination and biopsy history significantly increased predictive accuracy by 7% from 0.73 to 0.80 (p

Original languageEnglish
Pages (from-to)1144-1150
Number of pages7
JournalJournal of Urology
Issue number4
Publication statusPublished - Oct 2012


  • biopsy
  • nomograms
  • prostate
  • prostate-specific antigen
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology


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