Abstract

BackgroundA new generation of risk calculators (RCs) for prostate cancer (PCa) incorporating magnetic resonance imaging (MRI) data have been introduced. However, these have not been validated externally, and their clinical benefit compared with alternative approaches remains unclear. ObjectiveTo assess previously published PCa RCs incorporating MRI data, and compare their performance with traditional RCs (European Randomized Study of Screening for Prostate Cancer [ERSPC] 3/4 and Prostate Biopsy Collaborative Group [PBCG]) and the blood-based Stockholm3 test. Design, setting, and participantsRCs were tested in a prospective multicenter cohort including 532 men aged 45–74 yr participating in the Stockholm3-MRI study between 2016 and 2017. Outcome measurements and statistical analysisThe probabilities of detection of clinically significant PCa (csPCa) defined as Gleason score ≥3 + 4 were calculated for each patient. For each RC and the Stockholm3 test, discrimination was assessed by area under the curve (AUC), calibration by numerical and graphical summaries, and clinical usefulness by decision curve analysis (DCA). Results and limitationsThe discriminative ability of MRI RCs 1–4 for the detection of csPCa was superior (AUC 0.81–0.87) to the traditional RCs (AUC 0.76–0.80). The observed prevalence of csPCa in the cohort was 37%, but calibration-in-the-large predictions varied from 14% to 63% across models. DCA identified only one model including MRI data as clinically useful at a threshold probability of 10%. The Stockholm3 test achieved equivalent performance for discrimination (AUC 0.86) and DCA, but was underpredicting the actual risk. ConclusionsAlthough MRI RCs discriminated csPCa better than traditional RCs, their predicted probabilities were variable in accuracy, and DCA identified only one model as clinically useful. Patient summaryNovel risk calculators (RCs) incorporating imaging improved the ability to discriminate clinically significant prostate cancer compared with traditional tools. However, all but one predicted divergent compared with actual risks, suggesting that regional modifications be implemented before usage. The Stockholm3 test achieved performance comparable with the best MRI RC without utilization of imaging.

Highlights

  • Prostate-specific antigen (PSA) testing leads to increased prostate cancer detection and a shift from advanced to earlier-stage tumors [1,2]

  • Multiparametric magnetic resonance imaging of the prostate has become widely accepted based on its high sensitivity and specificity for the detection of clinically significant prostate cancer [9,10] and its potential to reduce unnecessary biopsies in up to 50% of men [11,12]

  • The discriminative ability of risk calculators (RCs) incorporating magnetic resonance imaging (MRI) information for the detection of clinically significant PCa (csPCa) was superior to the conventional RCs (Fig. 1A)

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Summary

Introduction

Prostate-specific antigen (PSA) testing leads to increased prostate cancer detection and a shift from advanced to earlier-stage tumors [1,2]. A new generation of risk calculators (RCs) for prostate cancer (PCa) incorporating magnetic resonance imaging (MRI) data have been introduced. These have not been validated externally, and their clinical benefit compared with alternative approaches remains unclear. Objective: To assess previously published PCa RCs incorporating MRI data, and compare their performance with traditional RCs (European Randomized Study of Screening for Prostate Cancer [ERSPC] 3/4 and Prostate Biopsy Collaborative Group [PBCG]) and the blood-based Stockholm test. Conclusions: MRI RCs discriminated csPCa better than traditional RCs, their predicted probabilities were variable in accuracy, and DCA identified only one model as clinically useful. Patient summary: Novel risk calculators (RCs) incorporating imaging improved the ability to discriminate clinically significant prostate cancer compared with traditional tools. The Stockholm test achieved performance comparable with the best MRI RC without utilization of imaging

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