A Contemporary Prostate Biopsy Risk Calculator Based on Multiple Heterogeneous Cohorts

Donna P Ankerst, Johanna Straubinger, Katharina Selig, Lourdes Guerrios, Amanda De Hoedt, Javier Hernandez, Michael A Liss, Robin J Leach, Stephen J. Freedland, Michael W. Kattan, Robert Nam, Alexander Haese, Francesco Montorsi, Stephen A. Boorjian, Matthew R. Cooperberg, Cedric Poyet, Emily Vertosick, Andrew J. Vickers

Research output: Contribution to journalArticle

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Abstract

Background: Prostate cancer prediction tools provide quantitative guidance for doctor-patient decision-making regarding biopsy. The widely used online Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) utilized data from the 1990s based on six-core biopsies and outdated grading systems. Objective: We prospectively gathered data from men undergoing prostate biopsy in multiple diverse North American and European institutions participating in the Prostate Biopsy Collaborative Group (PBCG) in order to build a state-of-the-art risk prediction tool. Design, setting, and participants: We obtained data from 15 611 men undergoing 16 369 prostate biopsies during 2006–2017 at eight North American institutions for model-building and three European institutions for validation. Outcome measurements and statistical analysis: We used multinomial logistic regression to estimate the risks of high-grade prostate cancer (Gleason score ≥7) on biopsy based on clinical characteristics, including age, prostate-specific antigen, digital rectal exam, African ancestry, first-degree family history, and prior negative biopsy. We compared the PBCG model to the PCPTRC using internal cross-validation and external validation on the European cohorts. Results and limitations: Cross-validation on the North American cohorts (5992 biopsies) yielded the PBCG model area under the receiver operating characteristic curve (AUC) as 75.5% (95% confidence interval: 74.2–76.8), a small improvement over the AUC of 72.3% (70.9–73.7) for the PCPTRC (p < 0.0001). However, calibration and clinical net benefit were far superior for the PBCG model. Using a risk threshold of 10%, clinical use of the PBCG model would lead to the equivalent of 25 fewer biopsies per 1000 patients without missing any high-grade cancers. Results were similar on external validation on 10 377 European biopsies. Conclusions: The PBCG model should be used in place of the PCPTRC for prediction of prostate biopsy outcome. Patient summary: A contemporary risk tool for outcomes on prostate biopsy based on the routine clinical risk factors is now available for informed decision-making. A North American multicohort-based risk tool for predicting prostate cancer outcomes on biopsy has been developed and outperformed a leading North American risk tool in validation. It is now available online for patients and their providers.

LanguageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - Jan 1 2018

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Prostate
Biopsy
Prostatic Neoplasms
Area Under Curve
Decision Making
Neoplasm Grading
Prostate-Specific Antigen
ROC Curve
Calibration

Keywords

  • Digital rectal exam
  • Family history
  • High-grade disease
  • Prostate cancer
  • Prostate-specific antigen
  • Risk prediction

ASJC Scopus subject areas

  • Urology

Cite this

A Contemporary Prostate Biopsy Risk Calculator Based on Multiple Heterogeneous Cohorts. / Ankerst, Donna P; Straubinger, Johanna; Selig, Katharina; Guerrios, Lourdes; De Hoedt, Amanda; Hernandez, Javier; Liss, Michael A; Leach, Robin J; Freedland, Stephen J.; Kattan, Michael W.; Nam, Robert; Haese, Alexander; Montorsi, Francesco; Boorjian, Stephen A.; Cooperberg, Matthew R.; Poyet, Cedric; Vertosick, Emily; Vickers, Andrew J.

In: European Urology, 01.01.2018.

Research output: Contribution to journalArticle

Ankerst, DP, Straubinger, J, Selig, K, Guerrios, L, De Hoedt, A, Hernandez, J, Liss, MA, Leach, RJ, Freedland, SJ, Kattan, MW, Nam, R, Haese, A, Montorsi, F, Boorjian, SA, Cooperberg, MR, Poyet, C, Vertosick, E & Vickers, AJ 2018, 'A Contemporary Prostate Biopsy Risk Calculator Based on Multiple Heterogeneous Cohorts' European Urology. https://doi.org/10.1016/j.eururo.2018.05.003
Ankerst, Donna P ; Straubinger, Johanna ; Selig, Katharina ; Guerrios, Lourdes ; De Hoedt, Amanda ; Hernandez, Javier ; Liss, Michael A ; Leach, Robin J ; Freedland, Stephen J. ; Kattan, Michael W. ; Nam, Robert ; Haese, Alexander ; Montorsi, Francesco ; Boorjian, Stephen A. ; Cooperberg, Matthew R. ; Poyet, Cedric ; Vertosick, Emily ; Vickers, Andrew J. / A Contemporary Prostate Biopsy Risk Calculator Based on Multiple Heterogeneous Cohorts. In: European Urology. 2018.
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title = "A Contemporary Prostate Biopsy Risk Calculator Based on Multiple Heterogeneous Cohorts",
abstract = "Background: Prostate cancer prediction tools provide quantitative guidance for doctor-patient decision-making regarding biopsy. The widely used online Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) utilized data from the 1990s based on six-core biopsies and outdated grading systems. Objective: We prospectively gathered data from men undergoing prostate biopsy in multiple diverse North American and European institutions participating in the Prostate Biopsy Collaborative Group (PBCG) in order to build a state-of-the-art risk prediction tool. Design, setting, and participants: We obtained data from 15 611 men undergoing 16 369 prostate biopsies during 2006–2017 at eight North American institutions for model-building and three European institutions for validation. Outcome measurements and statistical analysis: We used multinomial logistic regression to estimate the risks of high-grade prostate cancer (Gleason score ≥7) on biopsy based on clinical characteristics, including age, prostate-specific antigen, digital rectal exam, African ancestry, first-degree family history, and prior negative biopsy. We compared the PBCG model to the PCPTRC using internal cross-validation and external validation on the European cohorts. Results and limitations: Cross-validation on the North American cohorts (5992 biopsies) yielded the PBCG model area under the receiver operating characteristic curve (AUC) as 75.5{\%} (95{\%} confidence interval: 74.2–76.8), a small improvement over the AUC of 72.3{\%} (70.9–73.7) for the PCPTRC (p < 0.0001). However, calibration and clinical net benefit were far superior for the PBCG model. Using a risk threshold of 10{\%}, clinical use of the PBCG model would lead to the equivalent of 25 fewer biopsies per 1000 patients without missing any high-grade cancers. Results were similar on external validation on 10 377 European biopsies. Conclusions: The PBCG model should be used in place of the PCPTRC for prediction of prostate biopsy outcome. Patient summary: A contemporary risk tool for outcomes on prostate biopsy based on the routine clinical risk factors is now available for informed decision-making. A North American multicohort-based risk tool for predicting prostate cancer outcomes on biopsy has been developed and outperformed a leading North American risk tool in validation. It is now available online for patients and their providers.",
keywords = "Digital rectal exam, Family history, High-grade disease, Prostate cancer, Prostate-specific antigen, Risk prediction",
author = "Ankerst, {Donna P} and Johanna Straubinger and Katharina Selig and Lourdes Guerrios and {De Hoedt}, Amanda and Javier Hernandez and Liss, {Michael A} and Leach, {Robin J} and Freedland, {Stephen J.} and Kattan, {Michael W.} and Robert Nam and Alexander Haese and Francesco Montorsi and Boorjian, {Stephen A.} and Cooperberg, {Matthew R.} and Cedric Poyet and Emily Vertosick and Vickers, {Andrew J.}",
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T1 - A Contemporary Prostate Biopsy Risk Calculator Based on Multiple Heterogeneous Cohorts

AU - Ankerst, Donna P

AU - Straubinger, Johanna

AU - Selig, Katharina

AU - Guerrios, Lourdes

AU - De Hoedt, Amanda

AU - Hernandez, Javier

AU - Liss, Michael A

AU - Leach, Robin J

AU - Freedland, Stephen J.

AU - Kattan, Michael W.

AU - Nam, Robert

AU - Haese, Alexander

AU - Montorsi, Francesco

AU - Boorjian, Stephen A.

AU - Cooperberg, Matthew R.

AU - Poyet, Cedric

AU - Vertosick, Emily

AU - Vickers, Andrew J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Prostate cancer prediction tools provide quantitative guidance for doctor-patient decision-making regarding biopsy. The widely used online Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) utilized data from the 1990s based on six-core biopsies and outdated grading systems. Objective: We prospectively gathered data from men undergoing prostate biopsy in multiple diverse North American and European institutions participating in the Prostate Biopsy Collaborative Group (PBCG) in order to build a state-of-the-art risk prediction tool. Design, setting, and participants: We obtained data from 15 611 men undergoing 16 369 prostate biopsies during 2006–2017 at eight North American institutions for model-building and three European institutions for validation. Outcome measurements and statistical analysis: We used multinomial logistic regression to estimate the risks of high-grade prostate cancer (Gleason score ≥7) on biopsy based on clinical characteristics, including age, prostate-specific antigen, digital rectal exam, African ancestry, first-degree family history, and prior negative biopsy. We compared the PBCG model to the PCPTRC using internal cross-validation and external validation on the European cohorts. Results and limitations: Cross-validation on the North American cohorts (5992 biopsies) yielded the PBCG model area under the receiver operating characteristic curve (AUC) as 75.5% (95% confidence interval: 74.2–76.8), a small improvement over the AUC of 72.3% (70.9–73.7) for the PCPTRC (p < 0.0001). However, calibration and clinical net benefit were far superior for the PBCG model. Using a risk threshold of 10%, clinical use of the PBCG model would lead to the equivalent of 25 fewer biopsies per 1000 patients without missing any high-grade cancers. Results were similar on external validation on 10 377 European biopsies. Conclusions: The PBCG model should be used in place of the PCPTRC for prediction of prostate biopsy outcome. Patient summary: A contemporary risk tool for outcomes on prostate biopsy based on the routine clinical risk factors is now available for informed decision-making. A North American multicohort-based risk tool for predicting prostate cancer outcomes on biopsy has been developed and outperformed a leading North American risk tool in validation. It is now available online for patients and their providers.

AB - Background: Prostate cancer prediction tools provide quantitative guidance for doctor-patient decision-making regarding biopsy. The widely used online Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) utilized data from the 1990s based on six-core biopsies and outdated grading systems. Objective: We prospectively gathered data from men undergoing prostate biopsy in multiple diverse North American and European institutions participating in the Prostate Biopsy Collaborative Group (PBCG) in order to build a state-of-the-art risk prediction tool. Design, setting, and participants: We obtained data from 15 611 men undergoing 16 369 prostate biopsies during 2006–2017 at eight North American institutions for model-building and three European institutions for validation. Outcome measurements and statistical analysis: We used multinomial logistic regression to estimate the risks of high-grade prostate cancer (Gleason score ≥7) on biopsy based on clinical characteristics, including age, prostate-specific antigen, digital rectal exam, African ancestry, first-degree family history, and prior negative biopsy. We compared the PBCG model to the PCPTRC using internal cross-validation and external validation on the European cohorts. Results and limitations: Cross-validation on the North American cohorts (5992 biopsies) yielded the PBCG model area under the receiver operating characteristic curve (AUC) as 75.5% (95% confidence interval: 74.2–76.8), a small improvement over the AUC of 72.3% (70.9–73.7) for the PCPTRC (p < 0.0001). However, calibration and clinical net benefit were far superior for the PBCG model. Using a risk threshold of 10%, clinical use of the PBCG model would lead to the equivalent of 25 fewer biopsies per 1000 patients without missing any high-grade cancers. Results were similar on external validation on 10 377 European biopsies. Conclusions: The PBCG model should be used in place of the PCPTRC for prediction of prostate biopsy outcome. Patient summary: A contemporary risk tool for outcomes on prostate biopsy based on the routine clinical risk factors is now available for informed decision-making. A North American multicohort-based risk tool for predicting prostate cancer outcomes on biopsy has been developed and outperformed a leading North American risk tool in validation. It is now available online for patients and their providers.

KW - Digital rectal exam

KW - Family history

KW - High-grade disease

KW - Prostate cancer

KW - Prostate-specific antigen

KW - Risk prediction

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JO - European Urology

T2 - European Urology

JF - European Urology

SN - 0302-2838

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