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Keywords:

  • prostate neoplasms;
  • risk;
  • nomogram;
  • biopsy;
  • screening

Study Type – Prognosis (inception cohort)

Level of Evidence 1b

OBJECTIVE

• 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.

PATIENTS AND METHODS

• 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.

RESULTS

• 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.

CONCLUSIONS

• 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.