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Several nomograms for prostate cancer detection have recently been developed. Because the incidence of prostate cancer is lower in Chinese men, nomograms based on other populations cannot be directly applied to Chinese men. We, therefore, developed a model for predicting the probability of a positive initial prostate biopsy using clinical and laboratory data from a Chinese male population. Data were collected from 893 Chinese male referrals, 697 in the derivation set and 196 in the external validation set, who underwent initial prostate biopsies as individual screening. We analyzed age, prostate volume, total prostate-specific antigen (PSA), PSA density (PSAD), digital rectal examinations (DRE) and transrectal ultrasound (TRUS) echogenicity. Logistic regression analysis estimated odds ratio, 95% confidence intervals and P values. Independent predictors of a positive biopsy result included advanced age, small prostate volume, elevated total PSA, abnormal digital rectal examination, and hyperechoic or hypoechoic TRUS echogenicity. We developed a predictive nomogram for an initial positive biopsy using these variables. The area under the receiver-operating characteristic curve for the model was 88.8%, which was greater than that of the prediction based on total PSA alone (area under the receiver-operating characteristic curve 74.7%). If externally validated, the predictive probability was 0.827 and the accuracy rate was 78.1%, respectively. Incorporating clinical and laboratory data into a prebiopsy nomogram improved the prediction of prostate cancer compared with predictions based solely on the individual factors.

Objectives: Transitional cell carcinoma of the kidney is an ominous condition, compared with benign renal cysts. The diagnosis is usually made by pathological examination of the specimen. The pelvicalyceal hypoechoic lesion on ultrasound combined with hematuria, flank pain and urine atypical transitional cells should raise the suspicion of possible malignancy. The differentiation between hemorrhagic or infected benign cysts and malignant hypoechoic lesions of the kidney on the renal ultrasound is a diagnostic challenge. We presented a male patient diagnosed with urine cytology, renal ultrasound, enhanced multidetector computerized tomography, ureterocystoscopic biopsy, and then surgical intervention. Methods: Case report and literature review. Results: This 73-year-old gentleman presented to Taipei City Hospital, Zhongxiao Branch with right flank soreness and hematuria on August 12, 2016. Urine cytology revealed the presence of atypical transitional cells. The renal ultrasound revealed a hypoechoic lesion at B mode examination and hypovascular lesion at color Doppler examination (Fig 1a and Fig 1b). Enhanced multidetector computerized tomography showed bilateral renal cysts, chronic cystitis, enlargement of prostate gland and 2 filling defects in the lower pelvicalyceal areas (Fig 2a and 2b). The pathological findings of preoperative ureterocystoscopic biopsy showed low differentiated papillary transitional cell carcinoma of the lower pelvicalyceal system of right kidney (Fig 3), which arranged in papillary structure with mild to moderate nuclear atypia and showed no stromal invasion in this specimen. Conclusions: We highlighted that pelvicalyceal hypoechoic lesions combined with hematuria, flan pain and urine atypical transitional cells should be evaluated further for possible malignancy.

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