Princess Margaret Hospital, University of Toronto, Toronto, Canada.Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Study Type - Prognosis (inception cohort) Level of Evidence 1b.
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 single-institution Canadian cohort.
At Princess Margaret Hospital, 982 consecutive patients with PCPT-RC and ERSPC-RC covariables were prospectively catalogued before prostate biopsy for suspicion of prostate cancer (PCa). Receiver-operating characteristic (ROC) curves were generated for each calculator and prostate-specific antigen (PSA). Comparisons by area under the curve (AUC) and calibration plots were performed. Predictors of PCa were identified by univariable and multivariable logistic regression.
PCa was detected in 46% and high-grade (HG) PCa (Gleason ≥4) in 23% of subjects with a median PSA level of 6.02 ng/mL. Multivariable analysis identified transrectal ultrasonography nodule, prostate volume and PSA as the most important predictors of PCa and HG PCa. ROC curve analysis showed that the ERSPC-RC (AUC = 0.71) outperformed the PCPT-RC (AUC = 0.63) and PSA (AUC = 0.55), for PCa prediction, P < 0.001. The PCPT-RC was better calibrated in the higher prediction range (40-100%) than the ERSPC-RC, whereas the ERSPC-RC had better calibration and avoided more biopsies in the lower risk range (0-30%). Discrimination of the ERSPC-RC continued to be superior to the PCPT-RC when the cohort was stratified by different clinical variables.
The ERSPC-RC had better discrimination for predicting PCa compared to the PCPT-RC in this Canadian cohort. Calibration would need to be improved to allow routine use of the ERSPC-RC in Canadian practice. What's known on the subject? and What does the study add? The European Randomized Study of Screening for Prostate Cancer risk calculator (ERSPC-RC) has been validated in a European population and shown to outperform the Prostate Cancer Prevention Trial risk calculator (PCPT-RC) for predicting prostate cancer. However, the ERSPC-RC has not been validated in North America where the PCPT-RC has been extensively validated. This study is the first to compare these calculators in non-European patient cohort showing better performance of the ERSPC-RC, but poor calibration.
Trottier G, Roobol MJ, Lawrentschuk N, Boström PJ, Fernandes KA, Finelli A, Chadwick K, Evans A, van der Kwast TH, Toi A, Zlotta AR, Fleshner NE. Are you the author?
Reference: BJU Int. 2011 Apr 20. Epub ahead of print.