Prospective Multi-Institutional Study Evaluating the Performance of Prostate Cancer Risk Calculators

TLDR: The SRC performed better than the PRC, but neither one added clinical benefit for risk thresholds of less than 30%.

Abstract: Purpose Prostate cancer risk calculators incorporate many factors to evaluate an individual’s risk for prostate cancer We validated two common North American–based, prostate cancer risk calculators Patients and Methods We conducted a prospective, multi-institutional study of 2,130 patients who underwent a prostate biopsy for prostate cancer detection from five centers We evaluated the performance of the Sunnybrook nomogram– based prostate cancer risk calculator (SRC) and the Prostate Cancer Prevention Trial (PCPT) – based risk calculator (PRC) to predict the presence of any cancer and high-grade cancer We examined discrimination, calibration, and decision curve analysis techniques to evaluate the prediction models Results Of the 2,130 patients, 867 men (407%) were found to have cancer, and 1,263 (593%) did not have cancer Of the patients with cancer, 403 (465%) had a Gleason score of 7 or more The area under the [concentration-time] curve (AUC) for the SRC was 067 (95% CI, 065 to 069); the AUC for the PRC was 061 (95% CI, 059 to 064) The AUC was higher for predicting aggressive disease from the SRC (072; 95% CI, 070 to 075) compared with that from the PRC (067; 95% CI, 064 to 070) Decision curve analyses showed that the SRC performed better than the PRC for risk thresholds of more than 30% for any cancer and more than 15% for aggressive cancer Conclusion The SRC performed better than the PRC, but neither one added clinical benefit for risk thresholds of less than 30% Further research is needed to improve the AUCs of the risk calculators, particularly for higher-grade cancer J Clin Oncol 29:2959-2964 © 2011 by American Society of Clinical Oncology