Prostate Cancer Prevention Trial and European Randomized Study of Screening for Prostate Cancer Risk Calculators: A Performance Comparison in a Contemporary Screened Cohort

• Published in: European urology Vol. 58; no. 4; pp. 551 - 558
• Main Authors: Cavadas, Vítor, Osório, Luís, Sabell, Francisco, Teves, Frederico, Branco, Frederico, Silva-Ramos, Miguel
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier 01.10.2010
• Subjects: Aged; Biological and medical sciences; Cohort Studies; Europe; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - prevention & control; Retrospective Studies; Risk Assessment; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; Europe; Diagnosis; Risk calculators; Prostate biopsy; Prostate cancer; Performance evaluation; Nephrology; Urinary system disease; Prostate disease; Malignant tumor; Medical screening; Urology; Prevention; Anatomic pathology; Randomization; Biopsy; Cohort study; Risk factor; Clinical trial; Performance; Urogenital system; Male genital diseases; Prostate; Comparative study; Cancer
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2010.06.023

Abstract Background Several models can predict the risk of prostate cancer (PCa) on biopsy. Objective To evaluate the performance of the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators in detecting PCa in a contemporary screened cohort. Design, setting, and participants We analyzed prebiopsy characteristics of 525 consecutive screened patients submitted to biopsy, as required by the risk calculators, in one European center between 2006 and 2007. Measurements Comparisons were done using tests of accuracy (area under the receiver operating characteristic curve [AUC-ROC]), calibration plots, and decision curve analysis. Biopsy predictors were identified by univariate and multivariate logistic regression. Results and limitations PCa was detected in 35.2% of the subjects. Among predictors included in the calculators, the logarithmic transformations of prostate volume and prostate-specific antigen (PSA), digital rectal examination, previous biopsy status, and age were significantly associated with PCa; transrectal ultrasound abnormalities and family history were not. AUC-ROC for the ERSPC calculator was significantly higher than the PCPT calculator and PSA alone (80.1%, 74.4%, and 64.3%, respectively). Calibration plots showed better performance for the ERSPC calculator; nevertheless, ERSPC may underestimate risk, while PCPT tends to overestimate predictions. Decision curve analysis displayed higher net benefit for the ERSPC calculator; 9% and 23% unnecessary biopsies can be avoided if a threshold probability of 20% and 30%, respectively, is adopted. In contrast, the PCPT model displayed very limited benefit. Our findings apply to a screened European cohort submitted to extended biopsy schemes; consequently, caution should be exerted when considering different populations. Conclusions The ERSPC risk calculator, by incorporating several risks factors, can aid in the estimation of individual PCa risk and in the decision to perform biopsy. The ERSPC calculator outperformed the PCPT model, which is of very limited value, in a contemporary cohort of screened patients.