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Incorporating PHI in decision making: external validation of the Rotterdam risk calculators for detection of prostate cancer

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Abstract

Purpose

External validation of existing risk calculators (RC) to assess the individualized risk of detecting prostate cancer (PCa) in prostate biopsies is needed to determine their clinical usefulness. The objective was to externally validate the Rotterdam Prostate Cancer RCs 3 and 4 (RPCRC-3/4) and that incorporating PHI (RPCRC–PHI) in a contemporary Spanish cohort.

Methods

Multicenter prospective study that included patients suspicious of harboring PCa. Men who attended the urology consultation were tested for PHI before prostate biopsy. To evaluate the performance of the prediction models: discrimination (receiver operating characteristic (ROC) curves), calibration and net benefit [decision curve analysis (DCA)] were calculated. These analyses were carried out for detection of any PCa and clinically significant (cs)PCa, defined as ISUP grade ≥ 2.

Results

Among the 559 men included, 337 (60.28%) and 194 (34.7%) were diagnosed of PCa and csPCa, respectively. RPCRC–PHI had the best discrimination ability for detection of PCa and csPCa with AUCs of 0.85 (95%CI 0.82–0.88) and 0.82 (95%CI 0.78–0.85), respectively. Calibration plots showed that RPCRC-3/4 underestimates the risk of detecting PCa showing the need for recalibration. In DCA, RPCRC–PHI shows the highest net benefit compared to biopsy all men.

Conclusions

The RPCRC–PHI performed properly in a contemporary clinical setting, especially for prediction of csPCa.

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Funding

The Basque Foundation for Health Innovation and Research (BIOEF) from the Health Department of the Basque Government granted this project with 32.850€. Identification code: 2016111083.

Author information

Authors and Affiliations

  1. Department of Urology, Barrualde-Galdakao Integrated Health Organisation, Osakidetza Basque Health Service, Calle Itsasondo 10, 3B 48993, Getxo Bizkaia, Spain

    Leire Rius Bilbao

  2. Biocruces Bizkaia Health Research Institute, Barakaldo, Spain

    Leire Rius Bilbao, Carmen Valladares Gomez & Carmen Mar Medina

  3. Research Unit, Barrualde-Galdakao Integrated Health Organisation, Osakidetza Basque Health Service, Galdakao, Spain

    Urko Aguirre Larracoechea

  4. Kronikgune Institute for Health Services Research, Barakaldo, Spain

    Urko Aguirre Larracoechea

  5. Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Galdakao, Spain

    Urko Aguirre Larracoechea

  6. Department of Clinical Laboratory Medicine, Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation, Osakidetza Basque Health Service, Barakaldo, Spain

    Carmen Valladares Gomez

  7. Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Sebastiaan Remmers

  8. Department of Clinical Laboratory Medicine, Barrualde-Galdakao Integrated Health Organisation, Osakidetza Basque Health Service, Galdakao, Spain

    Carmen Mar Medina

Authors
  1. Leire Rius Bilbao
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  2. Urko Aguirre Larracoechea
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  3. Carmen Valladares Gomez
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  4. Sebastiaan Remmers
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  5. Carmen Mar Medina
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Consortia

Phi Basque Study Group

  • Leire Rius Bilbao
  • , Carmen Valladares Gomez
  • , Urko Aguirre Larracoechea
  • , Jose Gregorio Pereira Arias
  • , Pablo Arredondo Calvo
  • , Luis Felipe Urdaneta Salegui
  • , Victor Escobal Tamayo
  • , Juan Pablo Sanz Jaka
  • , Adrian Recio Ayesa
  •  & Javier Mar Medina

Contributions

L Rius: Project development, data collection, data management, manuscript writing, C Valladares: Project development, data management, writing editing, U Aguirre: Project development, data analysis, writing editing, S Remmers: Writing editing, JG Pereira: Data collection, P Arredondo: Data collection, LF Urdaneta: Data collection, V Escobal: Data collection, JP Sanz-Jaka: Data collection, A Recio: Data collection, J Mar: Project development, C Mar: Project development, writing editing.

Corresponding author

Correspondence to Leire Rius Bilbao.

Ethics declarations

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval and informed consent

The study was approved by the ethics and research committee of the coordinating center and all participants included in the study gave their written informed consent.

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The members of the Phi Basque Study Group are Appendix section.

Appendix: Phi Basque Study Group

Appendix: Phi Basque Study Group

Leire Rius Bilbao Department of Urology, Barrualde-Galdakao Integrated Health Organisation, Osakidetza Basque Health Service; Biocruces Bizkaia Health Research Institute; Carmen Valladares Gomez Department of Clinical Laboratory Medicine, Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation, Osakidetza Basque Health Service; Biocruces Bizkaia Health Research Institute; Urko Aguirre Larracoechea Research Unit, Barrualde-Galdakao Integrated Health Organisation, Osakidetza Basque Health Service; Kronikgune Institute for Health Services Research; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS); Jose Gregorio Pereira Arias Department of Urology, IMQ Zorrotzaurre Hospital; Pablo Arredondo Calvo Department of Urology, Barrualde-Galdakao Integrated Health Organisation, Osakidetza Basque Health Service; Luis Felipe Urdaneta Salegui Department of Urology, IMQ Zorrotzaurre Hospital; Victor Escobal Tamayo Department of Urology, Barakaldo-Sestao Integrated Health Organisation, Osakidetza Basque Health Service; Juan Pablo Sanz Jaka Department of Urology, Donostialdea Integrated Health Organisation, Osakidetza Basque Health Service; Adrian Recio Ayesa Department of Urology, Uribe Integrated Health Organisation Osakidetza Basque Health Service; Javier Mar Medina Research Unit, Debagoiena Integrated Health Organisation, Osakidetza Basque Health Service; Biodonostia Health Research Institute; Kronikgune Institute for Health Services Research; Carmen Mar Medina Department of Clinical Laboratory Medicine, Barrualde-Galdakao Integrated Health Organisation, Osakidetza Basque Health Service; Biocruces Bizkaia Health Research Institute.

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Rius Bilbao, L., Aguirre Larracoechea, U., Valladares Gomez, C. et al. Incorporating PHI in decision making: external validation of the Rotterdam risk calculators for detection of prostate cancer. World J Urol 42, 141 (2024). https://doi.org/10.1007/s00345-024-04833-5

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