Clash of the calculators: External validation of prostate cancer risk calculators in men undergoing mpMRI and transperineal biopsy

Wei, Gavin; Kelly, Brian D.; Timm, Brennan; Perera, Marlon; Lundon, Dara; Jack, Gregory S.; Bolton, Damien

doi:10.1002/bco2.58

Cited by 8 publications

(5 citation statements)

References 32 publications

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“…This manuscript is the first external validation study testing RC-R and RC-A in two centers within a "real-life" scenario. Contrary to previously published validation studies [11][12][13][14][15][16][17][18], our validation cohort had significant heterogeneity. We included patients with mpMRIs not performed by dedicated uro-radiologists but multiple radiologists with differing degrees of expertise.…”

Section: Discussionmentioning

confidence: 68%

“…Most recently, various research groups implemented mpMRI findings into the ERSPC-RC. Among these, the RCs of Radtke et al [9] and Alberts et al [10] showed the most promising results in internal and external validation studies [11][12][13][14][15][16][17][18]. As mpMRI quality is highly dependent on the radiologist's experience, among other factors, it is unclear whether these RCs accurately predict the risk of PCa and csPCa when including mpMRI reports not performed by dedicated uro-radiologists.…”

Section: Introductionmentioning

confidence: 99%

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External validation of two mpMRI-risk calculators predicting risk of prostate cancer before biopsy

Pallauf

Steinkohl²,

Zimmermann

et al. 2022

World J Urol

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Purpose Risk calculators (RC) aim to improve prebiopsy risk stratification. Their latest versions now include multiparametric magnetic resonance imaging (mpMRI) findings. For their implementation into clinical practice, critical external validations are needed. Methods We retrospectively analyzed the patient data of 554 men who underwent ultrasound-guided targeted and systematic prostate biopsies at 2 centers. We validated the mpMRI-RCs of Radtke et al. (RC-R) and Alberts et al. (RC-A), previously shown to predict prostate cancer (PCa) and clinically significant PCa (csPCa). We assessed these RCs’ prediction accuracy by analyzing the receiver-operating characteristics (ROC) curve and evaluated their clinical utility using Decision Curve Analysis (DCA), including Net-Benefit and Net-Reduction curves. Results We found that the Area Under the ROC Curve (AUC) for predicting PCa was 0.681 [confidence interval (CI) 95% 0.635–0.727] for RC-A. The AUCs for predicting csPCa were 0.635 (CI 95% 0.583–0.686) for RC-A and 0.676 (CI 95% 0.627–0.725) for RC-R. For example, at a risk threshold of 12%, RC-A needs to assess 334 and RC-R 500 patients to detect one additional true positive PCa or csPCa patient, respectively. At the same risk threshold of 12%, RC-A only needs to assess 6 and RC-R 16 patients to detect one additional true negative PCa or csPCa patient. Conclusion The mpMRI-RCs, RC-R and RC-A, are robust and valuable tools for patient counseling. Although they do not improve PCa and csPCa detection rates by a clinically meaningful margin, they aid in avoiding unnecessary prostate biopsies. Their implementation could reduce overdiagnosis and reduce PCa screening morbidity.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

External validation of two mpMRI-risk calculators predicting risk of prostate cancer before biopsy

Pallauf

Steinkohl²,

Zimmermann

et al. 2022

World J Urol

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“…Both calculators were better at discriminating between patients with and without cancer than PSA alone; however, the accuracy of predicted risk probabilities either overestimated or underestimated actual risk in several cohorts for each calculator and have not been adjusted for key populations such as by race or ethnicity [ 37 ]. Studies have evaluated the validity of using these risk calculators; however, it’s important to note that none of these studies were done in the context of a screening trial [ 67 , 68 ].…”

Section: Purpose and Backgroundmentioning

confidence: 99%

Screening for prostate cancer: protocol for updating multiple systematic reviews to inform a Canadian Task Force on Preventive Health Care guideline update

et al. 2022

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Purpose To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening for prostate cancer in adults aged 18 years and older in primary care. This protocol outlines the planned scope and methods for a series of systematic reviews. Methods Updates of two systematic reviews and a de novo review will be conducted to synthesize the evidence on the benefits and harms of screening for prostate cancer with a prostate-specific antigen (PSA) and/or digital rectal examination (DRE) (with or without additional information) and patient values and preferences. Outcomes for the benefits of screening include reduced prostate cancer mortality, all-cause mortality, and incidence of metastatic prostate cancer. Outcomes for the harms of screening include false-positive screening tests, overdiagnosis, complications due to biopsy, and complications of treatment including incontinence (urinary or bowel), and erectile dysfunction. The quality of life or functioning (overall and disease-specific) and psychological effects outcomes are considered as a possible benefit or harm. Outcomes for the values and preferences review include quantitative or qualitative information regarding the choice to screen or intention to undergo screening. For the reviews on benefits or harms, we will search for randomized controlled trials, quasi-randomized, and controlled studies in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. For the review on values and preferences, we will search for experimental or observational studies in MEDLINE, Embase, and PsycInfo. For all reviews, we will also search websites of relevant organizations, gray literature, and reference lists of included studies. Title and abstract screening, full-text review, data extraction, and risk of bias assessments will be completed independently by pairs of reviewers with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of the evidence for each outcome. Discussion The series of systematic reviews will be used by the Canadian Task Force on Preventive Health Care to update their 2014 guideline on screening for prostate cancer in adults aged 18 years and older. Systematic review registration This review has been registered with PROSPERO (CRD42022314407) and is available on the Open Science Framework (osf.io/dm32k).

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“…A variety of tools and risk calculators have also been developed and validated to aid in improved prebiopsy risk stratification and shared decision-making. These risk calculators have expanded from the use of clinical parameters alone to incorporation of mpMRI findings [3] , [4] , [5] , [6] , [7] , [8] .…”

Section: Introductionmentioning

confidence: 99%

A Novel Risk Calculator Incorporating Clinical Parameters, Multiparametric Magnetic Resonance Imaging, and Prostate-Specific Membrane Antigen Positron Emission Tomography for Prostate Cancer Risk Stratification Before Transperineal Prostate Biopsy

Kelly

Ptasznik

Roberts

et al. 2023

European Urology Open Science

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Clash of the calculators: External validation of prostate cancer risk calculators in men undergoing mpMRI and transperineal biopsy

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 8 publications

References 32 publications

External validation of two mpMRI-risk calculators predicting risk of prostate cancer before biopsy

External validation of two mpMRI-risk calculators predicting risk of prostate cancer before biopsy

Screening for prostate cancer: protocol for updating multiple systematic reviews to inform a Canadian Task Force on Preventive Health Care guideline update

A Novel Risk Calculator Incorporating Clinical Parameters, Multiparametric Magnetic Resonance Imaging, and Prostate-Specific Membrane Antigen Positron Emission Tomography for Prostate Cancer Risk Stratification Before Transperineal Prostate Biopsy

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