Prostate Cancer Risk Calculators for Healthy Populations: Systematic Review

Bandala-Jacques, Antonio; Esquivel, Kevin Daniel Castellanos; Pérez-Hurtado, Fernanda; Hernández-Silva, Cristobal; Reynoso-Noverón, Nancy

doi:10.2196/30430

Cited by 10 publications

(11 citation statements)

References 51 publications

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“…[ 19 , 65 ] Beyond their use in decision-making, risk calculators lead to a decrease in unnecessary procedures, thereby improving the utilization of medical resources. [ 65 ]…”

Section: Beyond Prostate-specific Antigen: Improvements In Screening ...mentioning

confidence: 99%

“…[46] Risk calculators use biomarkers and clinical variables (age, race, PSA level, DRE, family history, prior biopsy results, etc) to determine PCa risk and the decision to perform a biopsy. [19,65] Beyond their use in decision-making, risk calculators lead to a decrease in unnecessary procedures, thereby improving the utilization of medical resources. [65] The European Randomized Study of Screening for Prostate Cancer (ERSPC) developed the ERSPC risk calculator.…”

Section: Risk Predicting Modelsmentioning

confidence: 99%

“…[19,65] Beyond their use in decision-making, risk calculators lead to a decrease in unnecessary procedures, thereby improving the utilization of medical resources. [65] The European Randomized Study of Screening for Prostate Cancer (ERSPC) developed the ERSPC risk calculator. [46] Various versions are available online that are specific to patients and clinical practitioners.…”

Section: Risk Predicting Modelsmentioning

confidence: 99%

“…[46] The PCPT risk calculator developed according to the findings from the trial of the same name includes the novel marker T2:ERG. [46,65] The Stockholm-3 Model risk calculator incorporates data from several biomarkers, including human kallikrein 2, microseminoprotein β, and macrophage inhibitory cytokine 1, as well as individual clinical variables and 232 singleenucleotide polymorphisms. [47,57] It was found to decrease unnecessary biopsies by 32% (95% confidence interval, 24%-39%).…”

Section: Risk Predicting Modelsmentioning

confidence: 99%

“…[70] Nomograms with many of the aforementioned biomarkers and clinical variables can be combined to predict PCa and aid in personalized decision-making regarding biopsy. [46] According to Bandala-Jacques et al, [65] risk calculators are most useful when applied to the populations for which they are specifically created.…”

Section: Spdef Pca3mentioning

confidence: 99%

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Prostate cancer screening: Continued controversies and novel biomarker advancements

Tidd-Johnson¹,

Sebastian²,

Co³

et al. 2022

Curr Urol

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Prostate cancer (PCa) screening remains one of the most controversial topics in clinical and public health. Despite being the second most common cancer in men worldwide, recommendations for screening using prostate-specific antigen (PSA) are unclear. Early detection and the resulting postscreening treatment lead to overdiagnosis and overtreatment of otherwise indolent cases. In addition, several unwanted harms are associated with PCa screening process. This literature review focuses on the limitations of PSA-specific PCa screening, reasons behind the screening controversy, and the novel biomarkers and advanced innovative methodologies that improve the limitations of traditional screening using PSA. With the verdict of whether or not to screen not yet unanimous, we hope to aid in resolution of the long-standing debate.

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“…[ 19 , 65 ] Beyond their use in decision-making, risk calculators lead to a decrease in unnecessary procedures, thereby improving the utilization of medical resources. [ 65 ]…”

Section: Beyond Prostate-specific Antigen: Improvements In Screening ...mentioning

confidence: 99%

Section: Risk Predicting Modelsmentioning

confidence: 99%

Section: Risk Predicting Modelsmentioning

confidence: 99%

Section: Risk Predicting Modelsmentioning

confidence: 99%

Section: Spdef Pca3mentioning

confidence: 99%

See 3 more Smart Citations

Prostate cancer screening: Continued controversies and novel biomarker advancements

Tidd-Johnson¹,

Sebastian²,

Co³

et al. 2022

Curr Urol

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Personalized Multilevel Intervention for Improving Appropriate Use of Colorectal Cancer Screening in Older Adults

Saini,

Lewis,

Kerr

et al. 2023

JAMA Intern Med

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ImportanceDespite guideline recommendations, clinicians do not systematically use prior screening or health history to guide colorectal cancer (CRC) screening decisions in older adults.ObjectiveTo evaluate the effect of a personalized multilevel intervention on screening orders in older adults due for average-risk CRC screening.Design, Setting, and ParticipantsInterventional 2-group parallel unmasked cluster randomized clinical trial conducted from November 2015 to February 2019 at 2 US Department of Veterans Affairs (VA) facilities: 1 academic VA medical center and 1 of its connected outpatient clinics. Randomization at the primary care physician/clinician (PCP) level, stratified by study site and clinical full-time equivalency. Participants were 431 average-risk, screen-due US veterans aged 70 to 75 years attending a primary care visit. Data analysis was performed from August 2018 to August 2023.InterventionThe intervention group received a multilevel intervention including a decision-aid booklet with detailed information on screening benefits and harms, personalized for each participant based on age, sex, prior screening, and comorbidity. The control group received a multilevel intervention including a screening informational booklet. All participants received PCP education and system-level modifications to support personalized screening.Main Outcomes and MeasuresThe primary outcome was whether screening was ordered within 2 weeks of clinic visit. Secondary outcomes were concordance between screening orders and screening benefit and screening utilization within 6 months.ResultsA total of 436 patients were consented, and 431 were analyzed across 67 PCPs. Patients had a mean (SD) age of 71.5 (1.7) years; 424 were male (98.4%); 374 were White (86.8%); 89 were college graduates (21.5%); and 351 (81.4%) had undergone prior screening. A total of 258 (59.9%) were randomized to intervention, and 173 (40.1%) to control. Screening orders were placed for 162 of 258 intervention patients (62.8%) vs 114 of 173 control patients (65.9%) (adjusted difference, −4.0 percentage points [pp]; 95% CI, −15.4 to 7.4 pp). In a prespecified interaction analysis, the proportion receiving orders was lower in the intervention group than in the control group for those in the lowest benefit quartile (59.4% vs 71.1%). In contrast, the proportion receiving orders was higher in the intervention group than in the control group for those in the highest benefit quartile (67.6% vs 52.2%) (interaction P = .049). Fewer intervention patients (106 of 256 [41.4%]) utilized screening overall at 6 months than controls (96 of 173 [55.9%]) (adjusted difference, −13.4 pp; 95% CI, −25.3 to −1.6 pp).Conclusions and RelevanceIn this cluster randomized clinical trial, patients who were presented with personalized information about screening benefits and harms in the context of a multilevel intervention were more likely to receive screening orders concordant with benefit and were less likely to utilize screening.Trial RegistrationClinicalTrials.gov Identifier: NCT02027545

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Development and Validation of an 18-Gene Urine Test for High-Grade Prostate Cancer

Tosoian,

Zhang,

Xiao

et al. 2024

JAMA Oncol

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ImportanceBenefits of prostate cancer (PCa) screening with prostate-specific antigen (PSA) alone are largely offset by excess negative biopsies and overdetection of indolent cancers resulting from the poor specificity of PSA for high-grade PCa (ie, grade group [GG] 2 or greater).ObjectiveTo develop a multiplex urinary panel for high-grade PCa and validate its external performance relative to current guideline-endorsed biomarkers.Design, Setting, and ParticipantsRNA sequencing analysis of 58 724 genes identified 54 markers of PCa, including 17 markers uniquely overexpressed by high-grade cancers. Gene expression and clinical factors were modeled in a new urinary test for high-grade PCa (MyProstateScore 2.0 [MPS2]). Optimal models were developed in parallel without prostate volume (MPS2) and with prostate volume (MPS2+). The locked models underwent blinded external validation in a prospective National Cancer Institute trial cohort. Data were collected from January 2008 to December 2020, and data were analyzed from November 2022 to November 2023.ExposureProtocolized blood and urine collection and transrectal ultrasound-guided systematic prostate biopsy.Main Outcomes and MeasuresMultiple biomarker tests were assessed in the validation cohort, including serum PSA alone, the Prostate Cancer Prevention Trial risk calculator, and the Prostate Health Index (PHI) as well as derived multiplex 2-gene and 3-gene models, the original 2-gene MPS test, and the 18-gene MPS2 models. Under a testing approach with 95% sensitivity for PCa of GG 2 or greater, measures of diagnostic accuracy and clinical consequences of testing were calculated. Cancers of GG 3 or greater were assessed secondarily.ResultsOf 761 men included in the development cohort, the median (IQR) age was 63 (58-68) years, and the median (IQR) PSA level was 5.6 (4.6-7.2) ng/mL; of 743 men included in the validation cohort, the median (IQR) age was 62 (57-68) years, and the median (IQR) PSA level was 5.6 (4.1-8.0) ng/mL. In the validation cohort, 151 (20.3%) had high-grade PCa on biopsy. Area under the receiver operating characteristic curve values were 0.60 using PSA alone, 0.66 using the risk calculator, 0.77 using PHI, 0.76 using the derived multiplex 2-gene model, 0.72 using the derived multiplex 3-gene model, and 0.74 using the original MPS model compared with 0.81 using the MPS2 model and 0.82 using the MPS2+ model. At 95% sensitivity, the MPS2 model would have reduced unnecessary biopsies performed in the initial biopsy population (range for other tests, 15% to 30%; range for MPS2, 35% to 42%) and repeat biopsy population (range for other tests, 9% to 21%; range for MPS2, 46% to 51%). Across pertinent subgroups, the MPS2 models had negative predictive values of 95% to 99% for cancers of GG 2 or greater and of 99% for cancers of GG 3 or greater.Conclusions and RelevanceIn this study, a new 18-gene PCa test had higher diagnostic accuracy for high-grade PCa relative to existing biomarker tests. Clinically, use of this test would have meaningfully reduced unnecessary biopsies performed while maintaining highly sensitive detection of high-grade cancers. These data support use of this new PCa biomarker test in patients with elevated PSA levels to reduce the potential harms of PCa screening while preserving its long-term benefits.

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Prostate Cancer Risk Calculators for Healthy Populations: Systematic Review

Cited by 10 publications

References 51 publications

Prostate cancer screening: Continued controversies and novel biomarker advancements

Prostate cancer screening: Continued controversies and novel biomarker advancements

Personalized Multilevel Intervention for Improving Appropriate Use of Colorectal Cancer Screening in Older Adults

Development and Validation of an 18-Gene Urine Test for High-Grade Prostate Cancer

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