Prostate cancer risk assessment tools in an unscreened population
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To compare the prostate cancer prevention trial risk calculator (PCPT-RC) and European randomized study of screening for prostate cancer risk calculator (ERSPC-RC) in a unique unscreened population from the West of Ireland.
Patients and methods
Data was prospectively recorded for all 556 consecutive men who underwent prostate biopsy at our institution as part of the Rapid Access Prostate Assessment Clinic program in Ireland. The estimated probabilities of detecting prostate cancer and high-grade disease were calculated using the PCPT and ERSPC risk calculators. For each calculator the discriminative ability, calibration and clinical utility was assessed.
Prostate cancer was detected in 49 % and high-grade prostate cancer in 34 % of men. Receiver operating characteristic curve analysis demonstrated that the PCPT-RCs outperformed the ERSPC-RCs for the prediction of prostate cancer areas underneath the ROC curve (AUC 0.628 vs. 0.588, p = 0.0034) and for the prediction of high-grade prostate cancer (AUC 0.792 vs. 0.690, p = 0.0029). Both risk calculators generally over-predicted the risk of prostate cancer and high-grade disease across a wide range of predicted probabilities. Decision curve analysis suggested greater net benefit using the PCPT-RCs in this population.
Multivariable nomograms can further aid patient counselling for early prostate cancer detection. In unscreened men from Western Ireland, the PCPT-RCs provided better discrimination for overall prostate cancer and high-grade disease compared to the ERSPC-RC. However, both tools overpredicted the risk of cancer detection on biopsy, and it is possible that a different set of predictive variables may be more useful in this population.
KeywordsProstate cancer Nomogram Diagnosis Risk
Conflict of interest
DL and BW’s research is supported by the Irish Cancer Society as part of the Prostate Cancer Research Consortium, The Urology Foundation and the Irish Research Council. SL has received an honorarium for speaking at a cancer meeting; and this was unrelated to this study. BK, RF, JF, ER, GD and KW have no conflict of interest to declare.
All men in this study consented to undergo a 12 core sextant prostate biopsy and to participate in this institutional review board approved cohort study.
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