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. 2024 Feb 21:14:1343999.
doi: 10.3389/fonc.2024.1343999. eCollection 2024.

BioPrev-C - development and validation of a contemporary prostate cancer risk calculator

Thomas Hermanns  1 , Marian S Wettstein  1 , Basil Kaufmann  1 , Noémie Lautenbach  1 , Ernest Kaufmann  1 , Karim Saba  1 , Florian A Schmid  1 , Andreas M Hötker  2 , Michael Müntener  3 , Martin Umbehr  3 , Cédric Poyet  1
Affiliations

BioPrev-C - development and validation of a contemporary prostate cancer risk calculator

Thomas Hermanns et al. Front Oncol. .

Abstract

Objectives: To develop a novel biopsy prostate cancer (PCa) prevention calculator (BioPrev-C) using data from a prospective cohort all undergoing mpMRI targeted and transperineal template saturation biopsy.

Materials and methods: Data of all men who underwent prostate biopsy in our academic tertiary care center between 11/2016 and 10/2019 was prospectively collected. We developed a clinical prediction model for the detection of high-grade PCa (Gleason score ≥7) based on a multivariable logistic regression model incorporating age, PSA, prostate volume, digital rectal examination, family history, previous negative biopsy, 5-alpha-reductase inhibitor use and MRI PI-RADS score. BioPrev-C performance was externally validated in another prospective Swiss cohort and compared with two other PCa risk-calculators (SWOP-RC and PBCG-RC).

Results: Of 391 men in the development cohort, 157 (40.2%) were diagnosed with high-grade PCa. Validation of the BioPrev C revealed good discrimination with an area under the curve for high-grade PCa of 0.88 (95% Confidence Interval 0.82-0.93), which was higher compared to the other two risk calculators (0.71 for PBCG and 0.84 for SWOP). The BioPrev-C revealed good calibration in the low-risk range (0 - 0.25) and moderate overestimation in the intermediate risk range (0.25 - 0.75). The PBCG-RC showed good calibration and the SWOP-RC constant underestimation of high-grade PCa over the whole prediction range. Decision curve analyses revealed a clinical net benefit for the BioPrev-C at a clinical meaningful threshold probability range (≥4%), whereas PBCG and SWOP calculators only showed clinical net benefit above a 30% threshold probability.

Conclusion: BiopPrev-C is a novel contemporary risk calculator for the prediction of high-grade PCa. External validation of the BioPrev-C revealed relevant clinical benefit, which was superior compared to other well-known risk calculators. The BioPrev-C has the potential to significantly and safely reduce the number of men who should undergo a prostate biopsy.

Keywords: biopsy; decision aids; nomograms; prostate cancer; prostate-specific antigen.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Calibration plots for the BiopPrev-C (Right), the PBCG RC (middle) and the SWOP RC (left) predicting high-grade prostate cancer. The x-axis shows predicted probabilities by the models and the y-axis shows the observed values.
Figure 3
Figure 3
Discrimination of the three risk calculators using a ROC analysis with corresponding AUC values for discriminating a biopsy harbouring high-grade prostate cancer.
Figure 4
Figure 4
Decision curve analysis for the prediction of high-grade prostate cancer upon biopsy using the either BiopPrev-C, the PBCG RC or the SWOP RC. Decision cures examine the theoretical relationship between the threshold probability of prostate cancer biopsy outcome and the releative value of false-positive and false-negative results to determine the value (net benefit) of a predictive model. The horizontal line along the x-axis assumes that no patient will have prostate cancer (i.e no patient should undergo a prostate biopsy) whereas the solid gray line assumes that all patients will have high-grade prostate cancer (i.e., all patients will need to undergo prostate biopsy).
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