Predictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening. Few studies have compared the performance of both calculators across racial groups.
From 1485 prospectively recruited participants, 954 men were identified undergoing initial prostate biopsy for abnormal PSA or digital rectal examination in five Chicago hospitals between 2009 and 2014. Discrimination, calibration, and frequency of avoided biopsies were calculated to assess the performance of both risk calculators.
Of 954 participants, 463 (48.5%) were Black, 355 (37.2%) were White, and 136 (14.2%) identified as Other. Biopsy results were as follows: 310 (32.5%) exhibited no cancer, 323 (33.9%) indolent prostate cancer, and 321 (33.6%) clinically significant prostate cancer (csPCa). Differences in area under the curve (AUC)s for the detection of csPCa between PCPT and PBCG were not statistically different across all racial groups. PBCG did not improve calibration plots in Blacks and Others, as it showed higher levels of overprediction at most risk thresholds. PCPT led to an increased number of avoidable biopsies in minorities compared to PBCG at the 30% threshold (68% vs. 28% of all patients) with roughly similar rates of missed csPCa (23% vs. 20%).
Significant improvements were noticed in PBCG's calibrations and net benefits in Whites compared to PCPT. Since PBCG's improvements in Blacks are disputable and potentially biases a greater number of low risk Black and Other men towards unnecessary biopsies, PCPT may lead to better biopsy decisions in racial minority groups. Further comparisons of commonly used risk calculators across racial groups is warranted to minimize excessive biopsies and overdiagnosis in ethnic minorities.
BMC urology. 2019 Nov 27*** epublish ***
Samuel Carbunaru, Oluwarotimi S Nettey, Pooja Gogana, Irene B Helenowski, Borko Jovanovic, Maria Ruden, Courtney M P Hollowell, Roohollah Sharifi, Rick A Kittles, Edward Schaeffer, Peter Gann, Adam B Murphy
Department of Urology, Northwestern University Feinberg School of Medicine, 303 E Chicago Avenue, Tarry 16, Chicago, IL, 60611, USA., Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA., Division of Urology, Cook County Health and Hospitals System, 303 E Chicago Avenue, Tarry 16, Chicago, IL, 60611, USA., Section of Urology, Jesse Brown VA Medical Center, 303 E Chicago Avenue, Tarry 16, Chicago, IL, 60611, USA., Division of Health Equities, Department of Population Sciences, City of Hope Cancer Center, Duarte, CA, USA., Department of Pathology, University of Illinois at Chicago School of Medicine, Chicago, IL, USA., Department of Urology, Northwestern University Feinberg School of Medicine, 303 E Chicago Avenue, Tarry 16, Chicago, IL, 60611, USA. .