Prospective multi-institutional study evaluating the performance of prostate cancer risk calculators - Abstract

Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room MG-406, Toronto, Ontario, Canada, M4N 3M5.

Princess Margaret Hospital, Toronto East General Hospital, University of Toronto, Mount Sinai Hospital, Toronto, Canada: University of Western Ontario, London, Ontario; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada; The Cleveland Clinic, Cleveland, OH.



Prostate cancer risk calculators incorporate many factors to evaluate an individual's risk for prostate cancer. We validated two common North American-based, prostate cancer risk calculators.

We conducted a prospective, multi-institutional study of 2,130 patients who underwent a prostate biopsy for prostate cancer detection from five centers. We evaluated the performance of the Sunnybrook nomogram-based prostate cancer risk calculator (SRC) and the Prostate Cancer Prevention Trial (PCPT) -based risk calculator (PRC) to predict the presence of any cancer and high-grade cancer. We examined discrimination, calibration, and decision curve analysis techniques to evaluate the prediction models.

Of the 2,130 patients, 867 men (40.7%) were found to have cancer, and 1,263 (59.3%) did not have cancer. Of the patients with cancer, 403 (46.5%) had a Gleason score of 7 or more. The area under the [concentration-time] curve (AUC) for the SRC was 0.67 (95% CI, 0.65 to 0.69); the AUC for the PRC was 0.61 (95% CI, 0.59 to 0.64). The AUC was higher for predicting aggressive disease from the SRC (0.72; 95% CI, 0.70 to 0.75) compared with that from the PRC (0.67; 95% CI, 0.64 to 0.70). Decision curve analyses showed that the SRC performed better than the PRC for risk thresholds of more than 30% for any cancer and more than 15% for aggressive cancer.

The SRC performed better than the PRC, but neither one added clinical benefit for risk thresholds of less than 30%. Further research is needed to improve the AUCs of the risk calculators, particularly for higher-grade cancer.

Written by:
Nam RK, Kattan MW, Chin JL, Trachtenberg J, Singal R, Rendon R, Klotz LH, Sugar L, Sherman C, Izawa J, Bell D, Stanimirovic A, Venkateswaran V, Diamandis EP, Yu C, Loblaw DA, Narod SA.   Are you the author?

Reference: J Clin Oncol. 2011 Jun 20. Epub ahead of print.
doi: 10.1200/JCO.2010.32.6371

PubMed Abstract
PMID: 21690464 Prostate Cancer Section