Prostate cancer risk prediction using the novel versions of the ERSPC and PCPT risk calculators: Independent validation and comparison in a contemporary European cohort

Abstract

OBJECTIVES: To externally validate and compare the two novel versions of the ERSPC- prostate cancer (PCa) risk-calculator (RC) and PCPT-RC.
PATIENTS AND METHODS: All men who underwent a transrectal prostate biopsy in a European tertiary care centre between 2004 and 2012 were retrospectively identified. The probability of detecting PCa and significant PCa (Gleason score ≥7) was calculated for each man using the novel versions of the ERSPC-RC (DRE-based version 3 / 4) and the PCPT-RC (version 2.0) and compared with the biopsy results. Calibration and discrimination were assessed using the calibration slope method and the area under the receiver operating characteristic curve (AUC), respectively. Additionally, decision curve analyses were performed.
RESULTS: Of 1996 men, 483 (24%) were diagnosed with PCa and 226 (11%) with significant PCa. Calibration of the two RCs was comparable, although the PCPT-RC was slightly superior in the higher risk prediction range for any and significant PCa. Discrimination of the ERSPC- and PCPT-RC was comparable for any PCa (AUCs: 0.65 vs. 0.66), while the ERSPC-RC was somewhat better for significant PCa (AUCs: 0.73 vs. 0.70). Decision curve analyses revealed a comparable net benefit for any PCa and a slightly greater net benefit for significant PCa using the ERSPC-RC.
CONCLUSIONS: In our independent external validation, both updated RCs showed less optimistic performance compared to their original reports particularly for the prediction of any PCa. Risk prediction of significant PCa, which is important to avoid unnecessary biopsies and reduce overdiagnosis and overtreatment, was better for both RCs and slightly superior using the ERSPC-RC. This article is protected by copyright. All rights reserved.