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

Abstract

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.

Prostate cancer risk prediction and the persistence of uncertainty

“…Asides from the validatory nature of this paper [1], there are several other findings though less novel, which are further important additions to the urological literature.…”

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Poyet et al [1] have performed the largest external validation of the European Randomised Study for Screening of Prostate Cancer (ERSPC) and Prostate Cancer Prevention Trial (PCPT) v2.0 risk calculators (RCs) to date, having retrospectively identified 1996 men undergoing prostate biopsy in a Swiss tertiary care facility.Asides from the validatory nature of this paper [1], there are several other findings though less novel, which are further important additions to the urological literature.This study confirms the superior discriminative performance of multi-factorial RCs over PSA alone in the assessment of prostate cancer: where the area under the receiver operating characteristic curve (AUC) for the prediction of significant prostate cancer for PSA alone was 0.65, comparing less favourably than 0.73 and 0.70 for the ERSPC and PCPT v2.0 RCs, respectively.The authors performed sensitivity analysis showing higher detection rates for prostate cancer (29.4% vs 18.1%) and significant prostate cancer (15.9% vs 5.9%) in patients receiving a 12-core biopsy than in those receiving a 6-8 core biopsy.Supplementary analysis by the authors evaluated the performance of previous versions of the PCPT-RC, specifically v1.0 and PCPT-RC v1.0 with prostate volume. The inclusion of prostate volume demonstrated an improved predictive ability of this RC.

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“…Poyet et al [1] have performed the largest external validation of the European Randomised Study for Screening of Prostate Cancer (ERSPC) and Prostate Cancer Prevention Trial (PCPT) v2.0 risk calculators (RCs) to date, having retrospectively identified 1996 men undergoing prostate biopsy in a Swiss tertiary care facility.…”

What's new in screening in 2015?

“…[62] Smaller studies confirmed performance of multivariate prediction over a PSA and DRE based algorithms. [63, 64]…”

Canadian Urological Association recommendations on prostate cancer screening and early diagnosis

“…Although all of these calculators can be used to estimate the risk of harbouring clinically significant prostate cancer prior to prostate biopsy, they again display only moderate predictive accuracy, which varies across different study populations. 88,[93][94][95][96] Nonetheless, their online availability, ease of use, and improvement upon PSA alone make them attractive adjuncts when counselling patients considering undergoing prostate biopsy. Thus, prostate risk calculators can be used to estimate the risk of clinically significant prostate cancer in men presenting with an elevated PSA.…”