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External validation of the Rotterdam prostate cancer risk calculator within a high-risk Dutch clinical cohort

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Abstract

Purpose

This study aims to externally validate the Rotterdam Prostate Cancer Risk Calculator (RPCRC)-3/4 and RPCRC-MRI within a Dutch clinical cohort.

Methods

Men subjected to prostate biopsies, between 2018 and 2021, due to a clinical suspicion of prostate cancer (PCa) were retrospectively included. The performance of the RPCRC-3/4 and RPCRC-MRI was analyzed in terms of discrimination, calibration and net benefit. In addition, the need for recalibration and adjustment of risk thresholds for referral was investigated. Clinically significant (cs) PCa was defined as Gleason score ≥ 3 + 4.

Results

A total of 1575 men were included in the analysis. PCa was diagnosed in 63.2% (996/1575) of men and csPCa in 41.7% (656/1575) of men. Use of the RPCRC-3/4 could have prevented 37.3% (587/1575) of all MRIs within this cohort, thereby missing 18.3% (120/656) of csPCa diagnoses. After recalibration and adjustment of risk thresholds to 20% for PCa and 10% for csPCa, use of the recalibrated RPCRC-3/4 could have prevented 15.1% (238/1575) of all MRIs, resulting in 5.3% (35/656) of csPCa diagnoses being missed. The performance of the RPCRC-MRI was good; use of this risk calculator could have prevented 10.7% (169/1575) of all biopsies, resulting in 1.2% (8/656) of csPCa diagnoses being missed.

Conclusion

The RPCRC-3/4 underestimates the probability of having csPCa within this Dutch clinical cohort, resulting in significant numbers of csPCa diagnoses being missed. For optimal performance of a risk calculator in a specific cohort, evaluation of its performance within the population under study is essential.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital (NCI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Marinus J. Hagens, Piter J. Stelwagen, Hans Veerman, Jolien van Kesteren, Pim J. van Leeuwen & Henk G. van der Poel

  2. Prostate Cancer Network Netherlands, Amsterdam, The Netherlands

    Marinus J. Hagens, Hans Veerman, Sybren P. Rynja, Martijn Smeenge, Ton A. Roeleveld, Jolien van Kesteren, Pim J. van Leeuwen & Henk G. van der Poel

  3. Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands

    Marinus J. Hagens, Hans Veerman & Henk G. van der Poel

  4. Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands

    Piter J. Stelwagen & Ton A. Roeleveld

  5. Department of Urology, Spaarne Gasthuis, Hoofddorp, The Netherlands

    Sybren P. Rynja

  6. Department of Urology, Hospital St Jansdal, Harderwijk, The Netherlands

    Martijn Smeenge

  7. Department of Statistics, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands

    Vincent van der Noort

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

    Sebastiaan Remmers & Monique J. Roobol

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  1. Marinus J. Hagens
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Contributions

MJH: protocol/project development, data collection or management, manuscript writing/editing. PJS: protocol/project development, data collection or management, manuscript writing/editing. HV: manuscript writing/editing. SPR: manuscript writing/editing. MS: manuscript writing/editing. VvdN: manuscript writing/editing. TAR: manuscript writing/editing. JvK: manuscript writing/editing. SR: data analysis, manuscript writing/editing. MJR: manuscript writing/editing. PJvL: protocol/project development, manuscript writing/editing. HGvdP: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Marinus J. Hagens.

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Conflict of interest

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

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the Institutional Review Board (IRB) who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB (IRBd21-173).

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Hagens, M.J., Stelwagen, P.J., Veerman, H. et al. External validation of the Rotterdam prostate cancer risk calculator within a high-risk Dutch clinical cohort. World J Urol 41, 13–18 (2023). https://doi.org/10.1007/s00345-022-04185-y

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