The impact of prostate volume, number of biopsy cores and American Urological Association symptom score on the sensitivity of cancer detection using the Prostate Cancer Prevention Trial risk calculator

Abstract

Purpose: We assessed the independent predictive value of prostate volume, number of biopsy cores and AUASS (American Urological Association symptom score) compared to risk factors included in the PCPTRC (Prostate Cancer Prevention Trial risk calculator for prostate cancer) and PCPTHG (Prostate Cancer Prevention Trial risk calculator for high grade cancer [Gleason grade 7 or greater]).

Materials and methods: Of 5,519 PCPT (Prostate Cancer Prevention Trial) participants used to construct the PCPTRC 4,958 with AUASS and prostate specific antigen 10 ng/ml or less were included on logistic regression analysis. Risk algorithms were evaluated in 571 EDRN (Early Detection Research Network) participants using the ROC AUC.

Results: A total of 1,094 participants (22.1%) had prostate cancer, of whom 232 (21.2%) had high grade disease. For prostate cancer prediction higher prostate specific antigen, abnormal digital rectal examination, family history of prostate cancer and number of cores were associated with increased risk, while volume was associated with decreased risk. Excluding prostate volume and number of cores, a history of negative biopsy and increased AUASS were also associated with lower risk. For high grade cancer higher prostate specific antigen, abnormal digital rectal examination, black race and number of cores were associated with increased risk and volume, while AUASS was associated with decreased risk. The AUC of the PCPTRC adjusted for volume and number of cores was 72.7% (using EDRN data), 68.2% when adjusted for AUASS alone and 67.6% PCPTRC. For high grade disease the AUCs were 74.8%, 74.0% and 73.5% (PCPTHG), respectively.

Conclusions: Adjusted PCPT risk calculators for volume, number of cores and AUASS improve cancer detection.

Figure 1

PCPTRC_CLIN overall prostate cancer risk curves incorporating volume and number of cores, based on original PCPTRC and assuming white race, age 65 years, no prostate cancer family history, no prior biopsy, normal DRE, prostate volume 30, 42 and 57 cc, and 6 vs 12-core biopsy.

Figure 2

PCPTHG_CLIN high grade prostate cancer risk curves incorporating volume and number of cores vs original PCPTHG, assuming white race, age 65 years, no prostate cancer family history, no prior biopsy, normal DRE, prostate volume 30, 42 and 57 cc, and 6 vs 12-core biopsy.

Figure 3

PCPTRC_AUA overall prostate cancer risk curves incorporating AUASS and assuming white race, age 65 years, no prostate cancer family history, no prior biopsy, normal DRE and AUASS 0, 10, 20 or 30.

Figure 4

PCPTHG_AUA high grade prostate cancer risk curves incorporating AUASS and assuming white race, age 65 years, no prostate cancer family history, no prior biopsy, normal DRE and AUASS 0, 10, 20 or 30.

Figure 5

ROC curves evaluated on EDRN data set for overall prostate cancer for PCPTRC, PCPTRC_AUA and PCPTRC_CLIN.

Figure 6

ROC curves evaluated on EDRN dataset for high grade prostate cancer for PCPTHG, PCPTHG_AUA and PCPTHG_CLIN.