Senior Resident Medical Officer
A direct comparison of prostate cancer prediction models in a population undergoing multiparametric magnetic resonance imaging and only transperineal prostate biopsy
Paul Doan1,2, John Lahoud1, Lawrence H Kim1,2, Manish I Patel1,2.
1Urology, Westmead Hospital, Sydney, Australia; 2Surgery, The University of Sydney, Sydney, Australia
Introduction: To externally validate and compare the performance of the European Randomized Study of Screening for Prostate cancer risk calculator 3/4 (ERSPC-RC3/4), the Prostate Biopsy Collaborative Group risk calculator (PBCG RC) and the van Leeuwen model to determine which prediction model would perform the best in a contemporary Australian cohort undergoing only transperineal biopsy.
Methods: A retrospective review identified all patients undergoing transperineal biopsy across two centres. Of the 797 men identified, 373 had the data required to test all three risk calculators. The probability of clinically significant prostate cancer (csPC), defined as ISUPGG>1 was calculated for each patient. For each prediction model discrimination was assessed by area under the curve (AUC), calibration by numerical and graphical summaries and net benefit by decision curve analysis.
Results: Discrimination for detecting csPC showed the AUC of the ERSPC-RC3/4 to be 0.79(95%CI: 0.74-0.84), van Leeuwen to be 0.810.81(95%CI: 0.77-0.86) and the PBCG RC to be 0.68(95%CI: 0.63-0.74) compared to PSA alone which was 0.58(95%CI: 0.52-0.65). The ERSPC-RC3/4 was the best calibrated in the clinically relevant range of 12.5-50% whilst the van Leeuwen model was the best calibrated in the lower risk range of 0-25%. The van Leeuwen model demonstrated the greatest net benefit from 10% risk onwards, followed closely by the ERSPC-RC3/4 and then the PBCG model.
Conclusion: The ERPSC-RC3/4 demonstrated good performance and was comparable to the van Leeuwen model in all domains of discrimination, calibration and net benefit for an Australian population undergoing transperineal prostate biopsy. It is one of the most accessible risk calculators with an easy to use online platform, thus we recommend the use of the ERSPC-RC3/4 to predict risk in the clinical setting.
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