Prostate cancer risk assessment tools in an unscreened population

Lundon, Dara; Kelly, Brian D.; Foley, R.; Loeb, Stacy; Fitzpatrick, John M.; Watson, R. William G.; Rogers, Eamonn; Durkan, Garrett; Walsh, Kilian

doi:10.1007/s00345-014-1365-7

Cited by 27 publications

(18 citation statements)

References 13 publications

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“…However, their validation study was conducted in a relatively small cohort of only 337 patients and RC performance for significant prostate cancer was not assessed. In previous studies evaluating and comparing the older versions of the ERSPC‐ and PCPT‐RC, the performance of the RCs was also less optimistic in the validation cohorts compared with the original reports .…”

Section: Discussionmentioning

confidence: 95%

“…The European Randomised Study for Screening of Prostate Cancer (ERSPC)‐RC and the Prostate Cancer Prevention Trial (PCPT)‐RC are two well‐known prostate cancer RCs based on data from the Dutch arm of the ERSPC (15 758 men) and the placebo arm of the PCPT (5 519 men), respectively . Both RCs have been extensively validated in independent cohorts with distinct variation in performance among the different validation cohorts . Modifications of the original versions of both RCs have constantly been implemented to improve their performance.…”

Section: Introductionmentioning

confidence: 99%

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Prostate cancer risk prediction using the novel versions of the European Randomised Study for Screening of Prostate Cancer (ERSPC) and Prostate Cancer Prevention Trial (PCPT) risk calculators: independent validation and comparison in a contemporary European cohort

et al. 2015

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All men who underwent a transrectal prostate biopsy in a European tertiary care centre between 2004 and 2012 were retrospectively identified. The probability of detecting prostate cancer and significant cancer (Gleason score ≥7) was calculated for each man using the novel versions of the ERSPC-RC (DRE-based version 3/4) and the PCPT-RC (version 2.0) and compared with biopsy results. Calibration and discrimination were assessed using the calibration slope method and the area under the receiver operating characteristic curve (AUC), respectively. Additionally, decision curve analyses were performed. ResultsOf 1 996 men, 483 (24%) were diagnosed with prostate cancer and 226 (11%) with significant prostate cancer.Calibration of the two RCs was comparable, although the PCPT-RC was slightly superior in the higher risk prediction range for any and significant prostate cancer. Discrimination of the ERSPC-and PCPT-RC was comparable for any prostate cancer (AUCs 0.65 vs 0.66), while the ERSPC-RC was somewhat better for significant prostate cancer (AUCs 0.73 vs 0.70). Decision curve analyses revealed a comparable net benefit for any prostate cancer and a slightly greater net benefit for significant prostate cancer using the ERSPC-RC. ConclusionsIn our independent external validation, both updated RCs showed less optimistic performance compared with their original reports, particularly for the prediction of any prostate cancer. Risk prediction of significant prostate cancer, which is important to avoid unnecessary biopsies and reduce overdiagnosis and overtreatment, was better for both RCs and slightly superior using the ERSPC-RC.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Prostate cancer risk prediction using the novel versions of the European Randomised Study for Screening of Prostate Cancer (ERSPC) and Prostate Cancer Prevention Trial (PCPT) risk calculators: independent validation and comparison in a contemporary European cohort

et al. 2015

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“…To date, limited external validations and comparisons have been performed by different groups 6–9. The two most important recent comparisons of the modified RCs were performed by Foley et al 6 7 and Poyet et al 9.…”

Section: Introductionmentioning

confidence: 99%

Observational study comparing the accuracy/variability between the ERSPC and the PCPT risk calculators for the prediction of significant prostate cancer in patients with PSA <10 ng/mL

et al. 2019

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IntroductionRisk calculators (RCs) are easy-to-use tools considering available clinical variables that could help to select those patients with risk of prostate cancer (PCa) who should undergo a prostate biopsy.ObjectiveTo perform a comparison for the prediction of significant PCa (SigPCa) between the European Randomised Study of Screening for PCa (ERSPC) and the PCa Prevention Trial (PCPT) RCs in patients with prostate-specific antigen (PSA) between 3 and 10 ng/mL through an evaluation of the accuracy/variability between two consecutive PSA values.SettingAn observational study in a major university hospital in the south of Spain.Methods and participantsAn observational study was performed in patients who underwent a prostate biopsy. SigPCa probabilities were calculated with the two PSA measures using ERSPC3/4+digital rectal examination and PCPT v2+free PSA RCs. The prediction of SigPCa was determined by the area under the receiver operating characteristic curve (AUC). Calibration, discrimination and decision curve analysis were studied. The variability between both RCs’ agreement was compared using Cohen’s kappa coefficient.Results510 patients were analysed (87 diagnosed with SigPCa). The median PSA values were 5.3 and 5 ng/mL for PSA1 and PSA2, respectively. Both RCs overestimated the risk in the case of high-risk probabilities. Discriminative ability for SigPCa was similar between models with an AUC=0.73 (0.68–0.79) for ERSPC-RC versus 0.73 (0.67–0.79) for PCPT-RC. ERSPC-RC showed less variability than PCPT-RC, with a constant agreement (k=0.7–0.8) for usual range of clinical decision-making. Remarkably, a higher number of biopsies would be avoided using the ERSPC-RC, but more SigPCa would be missed along all the risk probabilities.ConclusionsBoth RCs performed similar in the prediction of SigPCa. However, ERSPC-RC seems to be more stable for intraindividual PSA variations.

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“…Both calculators were created in screening populations, and although they have been tested in cohorts of unscreened men, the percentage of patients diagnosed with PCa was considerably lower than that in the present study . Our previously published assessments of these risk calculators have yielded conflicting results . The present study addresses this conflict as it represents a considerably larger cohort of patients from a number of tertiary hospitals and seeks to use the most contemporary iterations of these calculators for a definitive assessment of their performance in the Irish population.…”

Section: Introductionmentioning

confidence: 85%

European Randomised Study of Screening for Prostate Cancer (ERSPC) risk calculators significantly outperform the Prostate Cancer Prevention Trial (PCPT) 2.0 in the prediction of prostate cancer: a multi‐institutional study

et al. 2016

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The performance of the risk calculators in the present cohort shows that the ERSPC-RC is a superior tool in the prediction of PCa; however the performance of the ERSPC-RC in this population does not yet warrant its use in clinical practice. The incorporation of the PHI score into the ERSPC-PHI risk calculator allowed each patient's risk to be more accurately quantified. Individual patient risk calculation using the ERSPC-PHI risk calculator can be undertaken in order to allow a systematic approach to patient risk stratification and to aid in the diagnosis of PCa.

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Prostate cancer risk assessment tools in an unscreened population

Cited by 27 publications

References 13 publications

Prostate cancer risk prediction using the novel versions of the European Randomised Study for Screening of Prostate Cancer (ERSPC) and Prostate Cancer Prevention Trial (PCPT) risk calculators: independent validation and comparison in a contemporary European cohort

Prostate cancer risk prediction using the novel versions of the European Randomised Study for Screening of Prostate Cancer (ERSPC) and Prostate Cancer Prevention Trial (PCPT) risk calculators: independent validation and comparison in a contemporary European cohort

Observational study comparing the accuracy/variability between the ERSPC and the PCPT risk calculators for the prediction of significant prostate cancer in patients with PSA <10 ng/mL

European Randomised Study of Screening for Prostate Cancer (ERSPC) risk calculators significantly outperform the Prostate Cancer Prevention Trial (PCPT) 2.0 in the prediction of prostate cancer: a multi‐institutional study

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