To analyse the performance of the Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) and two iterations of the European Randomised Study of Screening for Prostate Cancer Risk Calculator (ERSPC-RC), one of which incorporates prostate volume and another which incorporates prostate volume and the Prostate Health Index (ERSPC-PHI) in a referral population.
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The risk of prostate cancer (PCa) and significant PCa (Gleason ≥7) in 2,001 patients from 6 tertiary referral centres was calculated according to the PCPT-RC and ERSPC-RC formulae. The calculators' predictions were analysed using the area under the receiver operating characteristics curve (AUC), calibration plots, Hosmer-Lemeshow test for goodness of fit and decision curve analysis. In a subset of 222 patients for whom the Prostate Health Index (PHI) score was available, each patient's risk was calculated as per the ERSPC-RC and ERSPC-PHI risk calculator.
The ERSPC-RC outperformed the PCPT-RC in the prediction of PCa, with an AUC of 0. 71 compared to 0. 64 and also outperformed the PCPT-RC in the prediction of significant PCa (p<0. 001), with an AUC of 0. 74 compared to 0. 69. The ERSPC-RC demonstrated improved calibration in this cohort and was associated with a greater net benefit on decision curve analysis for both PCa and significant PCa. The performance of the ERSPC-RC was further improved through the addition of the PHI score in a subset of n=222 patients. The AUC of the ERSPC-PHI were 0. 76 and 0. 78 for PCa and significant PCa prediction respectively, in comparison to AUC values of 0. 72 in the prediction of both PCa and significant PCa for the ERSPC-RC (p=0. 12 and p=0. 04). The ERSPC-PHI RC was well calibrated in this cohort and demonstrated an increase in net benefit over that of the ERSPC-RC.
The performance of these calculators in this cohort demonstrates that the ERSPC-RC is a superior tool in the prediction of PCa. However the performance of the ERSPC-RC in this population does not yet warrant its use in clinical practice. The incorporation of the PHI score into the ERSPC-PHI risk calculator allowed each patient's risk to be more accurately quantified. Individual patient risk calculation using the ERSPC-PHI risk calculator can be undertaken in order to allow for a systematic approach to patient risk stratification and to aid in the diagnosis of PCa. This article is protected by copyright. All rights reserved.
BJU international. 2016 Feb 02 [Epub ahead of print]
Robert W Foley, Robert M Maweni, Laura Gorman, Keefe Murphy, Dara J Lundon, Garrett Durkan, Richard Power, Frank O'Brien, Kieran J O'Malley, David J Galvin, T Brendan Murphy, R William Watson
UCD School of Medicine, University College Dublin, Dublin, Ireland. , Croydon University Hospital, Croydon NHS Trust, London, United Kingdom. , UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland. , UCD School of Mathematical Sciences, University College Dublin, Dublin, Ireland. , UCD School of Medicine, University College Dublin, Dublin, Ireland. , Department of Urology, University Hospital Galway, Galway, Ireland. , Department of Urology, Beaumont Hospital, Dublin, Ireland. , Department of Urology, University Hospital Waterford, Waterford, Ireland. , Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland. , UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland. , UCD School of Mathematical Sciences, University College Dublin, Dublin, Ireland. , UCD School of Medicine, University College Dublin, Dublin, Ireland.