Adding a coefficient for race to the 4Kscore improves calibration for Black men Journal Article
| Authors: | Hougen, H. Y.; Sjoberg, D. D.; Thomas, J.; Mahal, B. A.; Vickers, A. J.; Punnen, S. |
| Article Title: | Adding a coefficient for race to the 4Kscore improves calibration for Black men |
| Abstract: | Purpose:Black men face a higher incidence of high-risk prostate cancer (PCa) compared with non-Black men. While the 4Kscore is a widely utilized commercial test for PCa risk assessment, it does not currently account for racial differences. The aim of this study is to describe and validate a prespecified race coefficient for the 4Kscore with the goal of improving the accuracy of this test for Black men.Materials and Methods:Using data from 85 Black men from the initial US prospective validation study, a race coefficient of 0.6 on the log-odds scale was prespecified. We calculated discrimination, calibration, and clinical utility of the 4Kscore with and without this coefficient for Black race in our primary analysis cohort of 205 Black men undergoing biopsy for PCa in a Veterans Affairs (VA) institution. We performed a sensitivity analysis using a combined cohort from the US prospective validation and the VA studies.Results:The mean probability of high-grade PCa from the 4Kscore in the primary cohort increased from 25% to 37% with race coefficient addition. Incorporating the race coefficient improved 4Kscore's calibration in Black men, with consequent improvements in clinical utility based on decision curve analysis. Model discrimination was maintained (AUC 0.825 vs 0.828, P =.14) in the combined cohort of Black and non-Black men from the US prospective and VA studies and the calibration remained largely unchanged.Conclusions:Incorporating a prespecified coefficient for Black race improved calibration and clinical utility of the 4Kscore among Black men and should be added to the 4Kscore. © 2024 Wolters Kluwer Health. All rights reserved. |
| Keywords: | adult; controlled study; middle aged; major clinical study; area under the curve; united states; prospective study; sensitivity analysis; biomarkers; biological marker; incidence; calibration; cohort analysis; validation study; risk assessment; prostate cancer; probability; prostate tumor; prostate biopsy; race difference; african americans; african american; veteran; race; prostate neoplasm; human; male; article; black person; data accuracy; prostate cancer prognostic test kit |
| Journal Title: | Journal of Urology |
| Volume: | 211 |
| Issue: | 3 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2024-03-01 |
| Start Page: | 392 |
| End Page: | 398 |
| Language: | English |
| DOI: | 10.1097/ju.0000000000003834 |
| PUBMED: | 38150383 |
| PROVIDER: | scopus |
| PMCID: | PMC10922923 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus |
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