Evaluating the Prostate Cancer Prevention Trial High Grade prostate cancer risk calculator in 10 international biopsy cohorts: results from the prostate biopsy collaborative group
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To assess the applicability of the Prostate Cancer Prevention Trial High Grade (Gleason grade ≥ 7) Risk Calculator (PCPTHG) in ten international cohorts, representing a range of populations.
A total of 25,512 biopsies from 10 cohorts (6 European, 1 UK and 3 US) were included; 4 implemented 6-core biopsies, and the remaining had 10 or higher schemes; 8 were screening cohorts, and 2 were clinical. PCPTHG risks were calculated using prostate-specific antigen, digital rectal examination, age, African origin and history of prior biopsy and evaluated in terms of calibration plots, areas underneath the receiver operating characteristic curve (AUC) and net benefit curves.
The median AUC of the PCPTHG for high-grade disease detection in the 10- and higher-core cohorts was 73.5 % (range, 63.9–76.7 %) compared with a median of 78.1 % (range, 72.0–87.6 %) among the four 6-core cohorts. Only the 10-core Cleveland Clinic cohort showed clear evidence of under-prediction by the PCPTHG, and this was restricted to risk ranges less than 15 %. The PCPTHG demonstrated higher clinical net benefit in higher-core compared with 6-core biopsy cohorts, and among the former, there were no notable differences observed between clinical and screening cohorts, nor between European and US cohorts.
The PCPTHG requires minimal patient information and can be applied across a range of populations. PCPTHG risk thresholds ranging from 5 to 20 %, depending on patient risk averseness, are recommended for clinical prostate biopsy decision-making.
KeywordsCalibration Discrimination Net benefit High-grade prostate cancer Risk
Statistics supported by a National Cancer Institute Cancer Center Support Grant for the Cancer Therapy and Research Center at the University of Texas Health Science Center at San Antonio [P30-CA054174]. Grants to support the work of the ERSPC include: European Union Grants SOC 95 35109, SOC 96 201869 05F022, SOC 97 201329, SOC 98 32241, the 6th Framework Program of the EU: PMark:LSHC-CT-2004-503011; The Dutch Cancer Society (KWF 94-869, 98-1657, 2002-277, 2006-3518); The Netherlands Organisation for Health Research and Development (ZonMW-002822820, 22000106, 50-50110-98-311); The Prostate Cancer Research Foundation of Rotterdam (SWOP); Institut National du Cancer convention 12-2008 Convention : 07/3D1616/SPC-111-13/NG-NC Appel à projets 2007 : Santé publique et Cancers Ligue Nationale Contre le cancer PROJET No. PRE08/AV-CONV. DRC 2009/119 (Tarn); Beckman-Coulter-Hybritech Inc; Abbott Pharmaceuticals, Sweden; Af Jochnick’s foundation; Catarina and Sven Hagstroms family foundation; Gunvor and Ivan Svensson’s foundation; Johanniterorden, King Gustav V Jubilée Clinic Cancer Research Foundation; Sahlgrenska University Hospital; Schering Plough, Sweden, Swedish Cancer Society (Contract numbers 09 0107, 080315 and 083455); Wallac Oy, Turkku, Finland. The Tyrol study is supported by the International Agency for Research on Cancer, Lyon and the Tyrolean Prostate Cancer Early Detection Group. The SABOR project is supported by the San Antonio Center of Biomarkers of Risk for Prostate Cancer CA086402. The ProtecT study is funded by the UK NIHR Health Technology Assessment Programme (projects 96/20/06, 96/20/99).
Conflict of interest
The authors declare that they have no conflict of interest.
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