pathological findings were recorded. A logistic regression model was constructed to evaluate predictors of cancer detection based on prebiopsy variables. The model was internally validated using the bootstrap statistical method, and a nomogram was constructed.
RESULTSProstate cancer was diagnosed in 1895 (33%) AA men and 991 (26%) Caucasians. AA men had a significantly higher mean serum PSA level than Caucasians, at 13.0 and 8.5 ng/mL, respectively ( P < 0.001). The mean ages were similar between AA and Caucasian men ( P = 0.23), but Caucasian men had a higher incidence of an abnormal DRE ( P < 0.001). On multivariate analysis, age, race, year of biopsy, PSA level, DRE, and number of cores taken were all statistically significant ( P < 0.001). Hazard ratios were (controlling for year of biopsy); age (1.30), Caucasian race (0.74), PSA level (1.47), DRE (1.75), and number of cores taken (1.19). The predicted model had a bootstrapped concordance index of 0.75.
CONCLUSIONAA race remains an independent predictor of prostate cancer detection in men undergoing initial prostate biopsy. This nomogram is the first to individualise the risk by AA or Caucasian race in a predictive model for counselling men on their probability of having cancer at the time of their first biopsy.
KEYWORDSprostate cancer, race, prostate biopsy, nomogram
OBJECTIVESTo construct a pre-biopsy predictive model incorporating several clinical variables, including African-American (AA) or Caucasian race, to predict the risk of prostate cancer detection on prostate biopsy, as traditionally AA men have had a higher incidence of prostate cancer than Caucasian men, but previous predictive tools for prostate cancer have not incorporated the effect of race.
We report our experience with vaginal extrusion of acellular porcine dermis in women undergoing pelvic reconstructive surgery. Over 5 years, 270 patients received a Pelvicol pubovaginal sling (PVS) or prolapse repair using interposition graft. Charts were retrospectively evaluated for evidence of graft extrusion, management, and outcomes. Chi-square analysis was conducted to evaluate the association of extrusion with perioperative variables. Nineteen women (7%) had partial or complete vaginal graft extrusion. After a PVS, 11 of 13 women healed by re-epithelialization and remained continent, while 2 required operative debridement. Four of six patients receiving interposition grafts healed after small incisional separations. Two women underwent additional surgery to address extensive extrusion, and both prolapses recurred. After statistical analysis, vaginal extrusion was significantly associated with PVS and concomitant urethral diverticulectomy. Small incisional separations frequently heal and cause no symptom recurrence. Larger areas of extrusion may require debridement and may contribute to recurrence of symptoms.
Race is not a predictor of prostate cancer detection in men undergoing repeat prostate biopsies. With the exception of HGPIN, all other clinical parameters were similar between black and white men. Serum PSA, PSA velocity, HGPIN and ASAP were found to be significant predictors of subsequent prostate cancer detection.
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