Eyre Stephen J, Ankerst Donna P, Wei John T, Nair Prakash V, Regan Meredith M, Bueti Gerrardina, Tang Jeffrey, Rubin Mark A, Kearney Michael, Thompson Ian M, Sanda Martin G
Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 20015, USA.
J Urol. 2009 Dec;182(6):2653-8. doi: 10.1016/j.juro.2009.08.056.
The Prostate Cancer Prevention Trial prostate cancer risk calculator was developed in a clinical trial cohort that does not represent men routinely referred for prostate biopsy. We assessed the generalizability of the Prostate Cancer Prevention Trial calculator in a cohort more representative of patients referred for consideration of prostate biopsy in American urology practice.
Patients undergoing prostate biopsy by 12 urologists at 5 sites were enrolled in an Early Detection Research Network cohort. The Prostate Cancer Prevention Trial risk calculator was validated by examining area underneath the receiver operating characteristic curve, sensitivity, specificity and calibration comparing observed vs predicted risk of prostate cancer detection.
Cancer incidence was greater (43% vs 22%, p = 0.001) in the Early Detection Research Network validation cohort (645) compared to the Prostate Cancer Prevention Trial group (5,519). Early Detection Research Network participants were younger and more racially diverse, and had more abnormal digital rectal examinations and higher prostate specific antigen than Prostate Cancer Prevention Trial participants (all p <0.001). Cancer severity was worse in the Early Detection Research Network cohort than in the Prostate Cancer Prevention Trial (Gleason 7 or higher 60% vs 21%, p <0.001). Nevertheless, the Prostate Cancer Prevention Trial risk calculator was superior to prostate specific antigen alone for predicting cancer in the Early Detection Research Network (AUC 0.691 vs 0.655, p = 0.009) and calibration confirmed that the Prostate Cancer Prevention Trial risk score accurately predicted individual risks in the Early Detection Research Network cohort.
Differences between the Early Detection Research Network validation cohort and the Prostate Cancer Prevention Trial cohort underscore the importance of validating calculator performance in the multicenter urology practice setting. Our findings extend the applicability of the Prostate Cancer Prevention Trial calculator for measuring the risk of prostate cancer detection on biopsy to the routine American urology practice setting.
前列腺癌预防试验前列腺癌风险计算器是在一个临床试验队列中开发的，该队列并不代表常规接受前列腺活检的男性。我们评估了前列腺癌预防试验计算器在美国泌尿外科实践中更具代表性的、考虑进行前列腺活检的患者队列中的通用性。
在5个地点由12位泌尿外科医生进行前列腺活检的患者被纳入早期检测研究网络队列。通过检查受试者工作特征曲线下面积、敏感性、特异性以及比较观察到的与预测的前列腺癌检测风险的校准情况，对前列腺癌预防试验风险计算器进行验证。
与前列腺癌预防试验组（5519例）相比，早期检测研究网络验证队列（645例）中的癌症发病率更高（43%对22%，p = 0.001）。早期检测研究网络的参与者更年轻，种族更加多样化，直肠指检异常情况更多，前列腺特异性抗原水平高于前列腺癌预防试验的参与者（所有p <0.001）。早期检测研究网络队列中的癌症严重程度比前列腺癌预防试验中的更差（Gleason评分7分或更高分别为60%对21%，p <0.001）。然而，前列腺癌预防试验风险计算器在预测早期检测研究网络中的癌症方面优于单独使用前列腺特异性抗原（受试者工作特征曲线下面积0.691对0.655，p = 0.009），校准结果证实前列腺癌预防试验风险评分能够准确预测早期检测研究网络队列中的个体风险。
早期检测研究网络验证队列与前列腺癌预防试验队列之间的差异凸显了在多中心泌尿外科实践环境中验证计算器性能的重要性。我们的研究结果将前列腺癌预防试验计算器在活检时测量前列腺癌检测风险的适用性扩展到了美国泌尿外科常规实践环境。
