A contemporary prostate biopsy risk calculator based on multiple heterogeneous cohorts Journal Article
| Authors: | Ankerst, D. P.; Straubinger, J.; Selig, K.; Guerrios, L.; De Hoedt, A.; Hernandez, J.; Liss, M. A.; Leach, R. J.; Freedland, S. J.; Kattan, M. W.; Nam, R.; Haese, A.; Montorsi, F.; Boorjian, S. A.; Cooperberg, M. R.; Poyet, C.; Vertosick, E.; Vickers, A. J. |
| Article Title: | A contemporary prostate biopsy risk calculator based on multiple heterogeneous cohorts |
| Abstract: | A North American multicohort-based risk tool for predicting prostate cancer outcomes on biopsy has been developed and outperformed a leading North American risk tool in validation. It is now available online for patients and their providers. Background: Prostate cancer prediction tools provide quantitative guidance for doctor-patient decision-making regarding biopsy. The widely used online Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) utilized data from the 1990s based on six-core biopsies and outdated grading systems. Objective: We prospectively gathered data from men undergoing prostate biopsy in multiple diverse North American and European institutions participating in the Prostate Biopsy Collaborative Group (PBCG) in order to build a state-of-the-art risk prediction tool. Design, setting, and participants: We obtained data from 15 611 men undergoing 16 369 prostate biopsies during 2006–2017 at eight North American institutions for model-building and three European institutions for validation. Outcome measurements and statistical analysis: We used multinomial logistic regression to estimate the risks of high-grade prostate cancer (Gleason score ≥7) on biopsy based on clinical characteristics, including age, prostate-specific antigen, digital rectal exam, African ancestry, first-degree family history, and prior negative biopsy. We compared the PBCG model to the PCPTRC using internal cross-validation and external validation on the European cohorts. Results and limitations: Cross-validation on the North American cohorts (5992 biopsies) yielded the PBCG model area under the receiver operating characteristic curve (AUC) as 75.5% (95% confidence interval: 74.2–76.8), a small improvement over the AUC of 72.3% (70.9–73.7) for the PCPTRC (p < 0.0001). However, calibration and clinical net benefit were far superior for the PBCG model. Using a risk threshold of 10%, clinical use of the PBCG model would lead to the equivalent of 25 fewer biopsies per 1000 patients without missing any high-grade cancers. Results were similar on external validation on 10 377 European biopsies. Conclusions: The PBCG model should be used in place of the PCPTRC for prediction of prostate biopsy outcome. Patient summary: A contemporary risk tool for outcomes on prostate biopsy based on the routine clinical risk factors is now available for informed decision-making. © 2018 European Association of Urology |
| Keywords: | adult; aged; major clinical study; clinical feature; cancer grading; prostate specific antigen; prediction; risk assessment; prostate cancer; gleason score; prostate-specific antigen; family history; prostate biopsy; digital rectal examination; african; clinical assessment tool; risk prediction; ancestry group; human; male; priority journal; article; digital rectal exam; high-grade disease; prostate biopsy risk calculator |
| Journal Title: | European Urology |
| Volume: | 74 |
| Issue: | 2 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2018-08-01 |
| Start Page: | 197 |
| End Page: | 203 |
| Language: | English |
| DOI: | 10.1016/j.eururo.2018.05.003 |
| PROVIDER: | scopus |
| PUBMED: | 29778349 |
| PMCID: | PMC6082177 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 August 2018 -- Source: Scopus |
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