Assessment of men’s risk thresholds to proceed with prostate biopsy for the early detection of prostate cancer

Koo, Kevin; Hyams, Elias S.

doi:10.1007/s11255-019-02196-0

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…2 PCa on prostate biopsy. 20 Net Benefit Curves. Net benefit curves were constructed from the calculated net benefit reported across probabilities by increments of 10% up to 100%, defined as the minimum probability of disease at which further intervention would be warranted, as net benefit [ sensitivity Â prevalence À (1 À specificity) Â (1 À prevalence) Â w, where w is the odds ratio at the threshold probability.…”

Section: Discussionmentioning

confidence: 99%

“…21 Biopsy Outcomes Comparison. Since patients have different risk thresholds for choosing to undergo biopsy with a median of 25% (IQR 10%-50%), 20,22 we evaluated the biopsy outcomes at the 10% and 30% risk thresholds.…”

Section: Discussionmentioning

confidence: 99%

“…Thirty percent reflects real-world risk thresholds for biopsy and the average risk of GG ≥ 2 PCa on prostate biopsy. 20…”

Section: Methodsmentioning

confidence: 99%

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Development and Validation of a Prostate Biopsy Risk Calculator in Black Men

Mistry,

Sun,

Sweis

et al. 2024

Journal of Urology

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Purpose: We sought to develop and validate a prostate biopsy risk calculator for Black men and compare it with the Prostate Cancer Prevention Trial version 2.0, Prostate Biopsy Collaborative Group, and Kaiser Permanente Prostate Cancer Risk Calculators for the detection of Gleason Grade Group (GG) ! 2 prostate cancer (PCa). Materials and Methods: We prospectively recruited 2 cohorts of men undergoing prostate biopsy from 5 facilities in Chicago. The first cohort was split into development (70%) and internal validation (30%) groups. The second was used for external validation. Iterative logistic regression was used to develop 3 models for predicting GG ! 2 PCa. Models were compared for discrimination using the C statistics, calibration curves, and net benefit curves. The frequency of unnecessary biopsies and missed PCas was compared at 10% and 30% risk thresholds. Results: The 2 cohorts included 393 and 292 Black men, respectively. Our first model, Mistry-Sun 1, used serum PSA and prior negative biopsy. Mistry-Sun 2 added abnormal digital rectal exam (DRE) and an interaction term with abnormal DRE and PSA to Mistry-Sun 1. Mistry-Sun 3 added prostate volume, abnormal DRE, and age to Mistry-Sun 1. The C statistics were 0.74, 0.74, and 0.78, respectively, and were similar to or higher than established calculators. At the 10% and 30% risk thresholds our models had the fewest unnecessary biopsies and an appropriate proportion of missed GG ! 2 PCas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Development and Validation of a Prostate Biopsy Risk Calculator in Black Men

Mistry,

Sun,

Sweis

et al. 2024

Journal of Urology

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“…There is also evidence of improved clinical utility for Black and non-Black men with low-risk thresholds from 0% to 25%, but 25% (IQR 10%-50%) is the median-risk threshold for patients. 3…”

mentioning

confidence: 99%

Editorial Comment

McCall,

Sun,

Murphy

2024

Journal of Urology

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incorporating the coefficient in Black patients from both cohorts still improved the calibration. Another limitation is that the available sample size did not allow for multiple iterations to optimally calibrate the model. As such, we took a pragmatic approach of prespecifying the coefficient which was accurate. The lack of central pathology review was also a limitation in this study that derived data from multiple VA centers. Lastly, we don't have information on prebiopsy prostate MRI, which is now becoming a standard of care and often used in conjunction with biomarkers in the prebiopsy setting.Currently, the 4Kscore test is a widely used biomarker to decide on the need for prostate biopsy, with approximately 75,000 tests ordered every year in clinical practice (personal communication, OPKO Diagnostics). In our study, use of the race coefficient provides a more accurate prediction of cancer risk among Black men. This could improve prostate cancer detection rates in the Black population. CONCLUSIONSWe report the independent validation of a prespecified race coefficient to improve the performance of a widely used preprostate biopsy risk stratification test, the 4Kscore, in Black men. Incorporation of the race coefficient into the 4Kscore algorithm maintained good discrimination and resulted in near perfect calibration in Black men, allowing for more reliable shared decision-making regarding the need for a biopsy. This evidence suggests the 4Kscore test should incorporate the race coefficient. Further research should examine whether genetic markers could replace the use of self-identified race in the 4Kscore algorithm.

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Lower urinary tract symptoms in elderly men: Considerations for prostate cancer testing

Schmit,

Malshy,

Ochsner

et al. 2024

The Prostate

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PurposeBoth lower urinary tract symptoms (LUTS) and prostate cancer (PCa) are common in elderly men. While LUTS are generally due to a benign etiology, they may provoke an evaluation with prostate‐specific antigen (PSA), which can lead to a cascade of further testing and possible overdiagnosis in patients with competing risks. There is limited patient and provider understanding of the relationship between LUTS and PCa risk, and a lack of clarity in how to evaluate these men to balance appropriate diagnosis of aggressive PCa with avoidance of overdiagnosis.MethodsA literature review was performed using keywords to query the electronic database PubMed. All articles published before November 2023 were screened by title and abstract for articles relevant to our subject.ResultsEpidemiological studies suggest that LUTS and PCa are largely independent in elderly men. The best available tools to assess PCa risk include PSA permutations, novel biomarkers, and imaging, but there are limitations in older men based on lack of validation in the elderly and unclear applicability of traditional definitions of “clinically significant” disease. We present a three‐tiered approach to evaluating these patients.ConclusionElderly men commonly have LUTS as well as a high likelihood of indolent PCa. A systematic and shared decision‐making‐based approach can help to balance objectives of appropriate detection of phenotypically dangerous disease and avoidance of over‐testing and overdiagnosis.

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Assessment of men’s risk thresholds to proceed with prostate biopsy for the early detection of prostate cancer

Cited by 5 publications

References 26 publications

Development and Validation of a Prostate Biopsy Risk Calculator in Black Men

Development and Validation of a Prostate Biopsy Risk Calculator in Black Men

Editorial Comment

Lower urinary tract symptoms in elderly men: Considerations for prostate cancer testing

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