Urology, Hospital Universitario Reina Sofia, Cordoba, Spain
Genitourinary Diseases, Maimonides Institute for Biomedical Research of Cordoba, Cordoba, Spain.
BMJ Open. 2019 Nov 12;9(11):e031032. doi: 10.1136/bmjopen-2019-031032.
Risk calculators (RCs) are easy-to-use tools considering available clinical variables that could help to select those patients with risk of prostate cancer (PCa) who should undergo a prostate biopsy.
To perform a comparison for the prediction of significant PCa (SigPCa) between the European Randomised Study of Screening for PCa (ERSPC) and the PCa Prevention Trial (PCPT) RCs in patients with prostate-specific antigen (PSA) between 3 and 10 ng/mL through an evaluation of the accuracy/variability between two consecutive PSA values.
An observational study in a major university hospital in the south of Spain.
An observational study was performed in patients who underwent a prostate biopsy. SigPCa probabilities were calculated with the two PSA measures using ERSPC3/4+digital rectal examination and PCPT v2+free PSA RCs. The prediction of SigPCa was determined by the area under the receiver operating characteristic curve (AUC). Calibration, discrimination and decision curve analysis were studied. The variability between both RCs' agreement was compared using Cohen's kappa coefficient.
510 patients were analysed (87 diagnosed with SigPCa). The median PSA values were 5.3 and 5 ng/mL for PSA1 and PSA2, respectively. Both RCs overestimated the risk in the case of high-risk probabilities. Discriminative ability for SigPCa was similar between models with an AUC=0.73 (0.68-0.79) for ERSPC-RC versus 0.73 (0.67-0.79) for PCPT-RC. ERSPC-RC showed less variability than PCPT-RC, with a constant agreement (k=0.7-0.8) for usual range of clinical decision-making. Remarkably, a higher number of biopsies would be avoided using the ERSPC-RC, but more SigPCa would be missed along all the risk probabilities.
Both RCs performed similar in the prediction of SigPCa. However, ERSPC-RC seems to be more stable for intraindividual PSA variations.
风险计算器（RC）是一种易于使用的工具，可考虑可用的临床变量，以帮助选择那些患有前列腺癌（PCa）风险的患者进行前列腺活检。
通过评估两个连续 PSA 值之间的准确性/可变性，比较欧洲前列腺癌筛查研究（ERSPC）和前列腺癌预防试验（PCPT）RC 在 PSA 为 3 至 10ng/mL 之间的患者中预测显著前列腺癌（SigPCa）的能力。
在西班牙南部的一家主要大学医院进行的观察性研究。
对接受前列腺活检的患者进行了一项观察性研究。使用 ERSPC3/4+数字直肠检查和 PCPT v2+游离 PSA RC 计算两次 PSA 测量的 SigPCa 概率。SigPCa 的预测通过接受者操作特征曲线（ROC）下的面积确定。研究了校准、判别和决策曲线分析。使用 Cohen's kappa 系数比较了两个 RC 之间的一致性变化。
共分析了 510 例患者（87 例诊断为 SigPCa）。PSA1 和 PSA2 的中位 PSA 值分别为 5.3 和 5ng/mL。两种 RC 均高估了高危概率的风险。模型对 SigPCa 的判别能力相似，ERSPC-RC 的 AUC 为 0.73（0.68-0.79），PCPT-RC 为 0.73（0.67-0.79）。ERSPC-RC 显示出比 PCPT-RC 更小的可变性，在通常的临床决策范围内具有一致的一致性（k=0.7-0.8）。值得注意的是，使用 ERSPC-RC 可以避免更多的活检，但在所有风险概率下都会错过更多的 SigPCa。
两种 RC 在预测 SigPCa 方面表现相似。然而，ERSPC-RC 似乎对个体内 PSA 变化更稳定。
