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Petersmann AL, Remmers S, Klein T, Manava P, Huettenbrink C, Pahernik SA, Distler FA. External validation of two MRI-based risk calculators in prostate cancer diagnosis. World J Urol 2021; 39:4109-4116. [PMID: 34169337 DOI: 10.1007/s00345-021-03770-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The diagnosis of (significant) prostate cancer ((s)PC) is impeded by overdiagnosis and unnecessary biopsy. Risk calculators (RC) have been developed to mitigate these issues. Contemporary RCs integrate clinical characteristics with mpMRI findings. OBJECTIVE To validate two of these models-the MRI-ERSPC-RC-3/4 and the risk model of van Leeuwen. METHODS 265 men with clinical suspicion of PC were enrolled. Every patient received a prebiopsy mpMRI, which was reported according to PI-RADS v2.1, followed by MRI/TRUS fusion-biopsy. Cancers with ISUP grade ≥ 2 were classified as sPC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statistical analysis was performed by comparing discrimination, calibration, and clinical utility RESULTS: There was no significant difference in discrimination between the RCs. The MRI-ERSPC-RC-3/4-RC showed a nearly ideal calibration-slope (0.94; 95% CI 0.68-1.20) than the van Leeuwen model (0.70; 95% CI 0.52-0.88). Within a threshold range up to 9% for a sPC, the MRI-ERSPC-RC-3/4-RC shows a greater net benefit than the van Leeuwen model. From 10 to 15%, the van Leeuwen model showed a higher net benefit compared to the MRI-ERSP-3/4-RC. For a risk threshold of 15%, the van Leeuwen model would avoid 24% vs. 14% compared to the MRI-ERSPC-RC-3/4 model; 6% vs. 5% sPC would be overlooked, respectively. CONCLUSION Both risk models supply accurate results and reduce the number of biopsies and basically no sPC were overlooked. The van Leeuwen model suggests a better balance between unnecessary biopsies and overlooked sPC at thresholds range of 10-15%. The MRI-ERSPC-RC-3/4 risk model provides better overall calibration.
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Affiliation(s)
- Anna-Lena Petersmann
- Department of Urology, Paracelsus Medical University Nuremberg, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany
| | - Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tilman Klein
- Department of Urology, Paracelsus Medical University Nuremberg, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany
| | - Panagiota Manava
- Institute of Radiology and Nuclear Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Clemens Huettenbrink
- Department of Urology, Paracelsus Medical University Nuremberg, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany
| | - Sascha A Pahernik
- Department of Urology, Paracelsus Medical University Nuremberg, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany
| | - Florian A Distler
- Department of Urology, Paracelsus Medical University Nuremberg, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany.
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Lange J, Remmers S, Gulati R, Bill-Axelson A, Johansson JE, Kwiatkowski M, Auvinen A, Hugosson J, Hu JC, Roobol MJ, Carlsson SV, Etzioni R. Impact of cancer screening on metastasis: A prostate cancer case study. J Med Screen 2021; 28:480-487. [PMID: 33563084 DOI: 10.1177/0969141321989738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Trials of cancer screening present results in terms of deaths prevented, but metastasis is also a key endpoint that screening seeks to prevent. We developed a framework for projecting overall (de novo and progressive) metastases prevented in a screening trial using prostate cancer screening as a case study. METHODS Mechanistic simulation model in which screening shifts a fraction of cases that would be metastatic at diagnosis to being non-metastatic. This shift increases the incidence of non-overdiagnosed, organ-confined cases. We use estimates of the risk of metastatic progression for these cases to project how many progress to metastasis after diagnosis and tally the projected de novo and progressive metastatic cases with and without screening. We use data on stage shift from the European Randomized Study of Screening for Prostate Cancer (ERSPC) and data on the risk of metastatic progression from the Scandinavian Prostate Cancer Group-4 trial. We estimate the relative risk and absolute risk reductions in metastatic disease at diagnosis and compare these with reductions in overall metastases. RESULTS Assuming no effect of screening beyond initial stage shift at diagnosis, the model projects a 43% reduction in metastasis at diagnosis but a 22% reduction in the cumulative probability of metastasis over 12 years in favor of screening. These results are consistent with the empirical findings from the ERSPC. CONCLUSION Any reduction in metastatic disease at diagnosis under screening is likely to be an overly optimistic predictor of the impact of screening on overall metastasis and disease-specific mortality.
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Affiliation(s)
- Jane Lange
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan-Erik Johansson
- Department of Urology, The School of Health and Medical Sciences Örebro, Örebro, Sweden.,Department of Urology, Örebro University Hospital, Örebro, Sweden
| | - Maciej Kwiatkowski
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland.,Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jim C Hu
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sigrid V Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Roobol MJ, Vedder MM, Nieboer D, Houlgatte A, Vincendeau S, Lazzeri M, Guazzoni G, Stephan C, Semjonow A, Haese A, Graefen M, Steyerberg EW. Comparison of Two Prostate Cancer Risk Calculators that Include the Prostate Health Index. Eur Urol Focus 2015; 1:185-190. [PMID: 28723432 DOI: 10.1016/j.euf.2015.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/12/2015] [Accepted: 06/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Risk prediction models for prostate cancer (PCa) have become important tools in reducing unnecessary prostate biopsies. The Prostate Health Index (PHI) may increase the predictive accuracy of such models. OBJECTIVES To compare two PCa risk calculators (RCs) that include PHI. DESIGN, SETTING, AND PARTICIPANTS We evaluated the predictive performance of a previously developed PHI-based nomogram and updated versions of the European Randomized Study of Screening for Prostate Cancer (ERSPC) RCs based on digital rectal examination (DRE): RC3 (no prior biopsy) and RC4 (prior biopsy). For the ERSPC updates, the original RCs were recalibrated and PHI was added as a predictor. The PHI-updated ERSPC RCs were compared with the Lughezzani nomogram in 1185 men from four European sites. Outcomes were biopsy-detectable PC and potentially advanced or aggressive PCa, defined as clinical stage >T2b and/or a Gleason score ≥7 (clinically relevant PCa). RESULTS AND LIMITATIONS The PHI-updated ERSPC models had a combined area under the curve for the receiver operating characteristic (AUC) of 0.72 for all PCa and 0.68 for clinically relevant PCa. For the Lughezzani PHI-based nomogram, AUCs were 0.75 for all PCa and 0.69 for clinically relevant PCa. For men without a prior biopsy, PHI-updated RC3 resulted in AUCs of 0.73 for PCa and 0.66 for clinically relevant PCa. Decision curves confirmed these patterns, although the number of clinically relevant cancers was low. CONCLUSION Differences between RCs that include PHI are small. Addition of PHI to an RC leads to further reductions in the rate of unnecessary biopsies when compared to a strategy based on prostate-specific antigen measurement. PATIENT SUMMARY Risk prediction models for prostate cancer have become important tools in reducing unnecessary prostate biopsies. We compared two risk prediction models for prostate cancer that include the Prostate Health Index. We found that these models are equivalent to each other, and both perform better than the prostate-specific antigen test alone in predicting cancer.
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Affiliation(s)
| | - Moniek M Vedder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Massimo Lazzeri
- Department of Urology, San Raffaele Hospital-Turro, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, San Raffaele Hospital-Turro, Milan, Italy
| | - Carsten Stephan
- Department of Urology, Charite-Universitaetsmedizin, Berlin, and Berlin Institute for Urologic Research, Berlin, Germany
| | - Axel Semjonow
- Prostate Centre, Department of Urology, University Hospital Münster, Münster, Germany
| | - Alexander Haese
- Prostate Cancer Centre, Martini Clinic, University Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Prostate Cancer Centre, Martini Clinic, University Hamburg-Eppendorf, Hamburg, Germany
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Loeb S. Prostate cancer screening: highlights from the 29th European association of urology congress stockholm, sweden, april 11-15, 2014. Rev Urol 2014; 16:90-91. [PMID: 25009450 PMCID: PMC4080855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, and the Manhattan Veterans Affairs Hospital New York, NY
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Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, Holmberg L, Kantoff P, Konety BR, Murad MH, Penson DF, Zietman AL. Early detection of prostate cancer: AUA Guideline. J Urol 2013; 190:419-26. [PMID: 23659877 DOI: 10.1016/j.juro.2013.04.119] [Citation(s) in RCA: 724] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE The guideline purpose is to provide the urologist with a framework for the early detection of prostate cancer in asymptomatic average risk men. MATERIALS AND METHODS A systematic review was conducted and summarized evidence derived from over 300 studies that addressed the predefined outcomes of interest (prostate cancer incidence/mortality, quality of life, diagnostic accuracy and harms of testing). In addition to the quality of evidence, the panel considered values and preferences expressed in a clinical setting (patient-physician dyad) rather than having a public health perspective. Guideline statements were organized by age group in years (age <40; 40 to 54; 55 to 69; ≥ 70). RESULTS Except prostate specific antigen-based prostate cancer screening, there was minimal evidence to assess the outcomes of interest for other tests. The quality of evidence for the benefits of screening was moderate, and evidence for harm was high for men age 55 to 69 years. For men outside this age range, evidence was lacking for benefit, but the harms of screening, including over diagnosis and overtreatment, remained. Modeled data suggested that a screening interval of two years or more may be preferred to reduce the harms of screening. CONCLUSIONS The Panel recommended shared decision-making for men age 55 to 69 years considering PSA-based screening, a target age group for whom benefits may outweigh harms. Outside this age range, PSA-based screening as a routine could not be recommended based on the available evidence.
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Affiliation(s)
- H Ballentine Carter
- American Urological Association Education and Research, Inc., Linthicum, Maryland, USA
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