Marinus J Hagens1,2,3, Piter J Stelwagen4,5, Hans Veerman4,6,7, Sybren P Rynja6,8, Martijn Smeenge6,9, Vincent van der Noort10, Ton A Roeleveld6,5, Jolien van Kesteren4,6, Sebastiaan Remmers11, Monique J Roobol11, Pim J van Leeuwen4,6, Henk G van der Poel4,6,7. 1. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital (NCI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. m.hagens@nki.nl. 2. Prostate Cancer Network Netherlands, Amsterdam, The Netherlands. m.hagens@nki.nl. 3. Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands. m.hagens@nki.nl. 4. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital (NCI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 5. Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. 6. Prostate Cancer Network Netherlands, Amsterdam, The Netherlands. 7. Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands. 8. Department of Urology, Spaarne Gasthuis, Hoofddorp, The Netherlands. 9. Department of Urology, Hospital St Jansdal, Harderwijk, The Netherlands. 10. Department of Statistics, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands. 11. Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract
PURPOSE: This study aims to externally validate the Rotterdam Prostate Cancer Risk Calculator (RPCRC)-3/4 and RPCRC-MRI within a Dutch clinical cohort. METHODS: Men subjected to prostate biopsies, between 2018 and 2021, due to a clinical suspicion of prostate cancer (PCa) were retrospectively included. The performance of the RPCRC-3/4 and RPCRC-MRI was analyzed in terms of discrimination, calibration and net benefit. In addition, the need for recalibration and adjustment of risk thresholds for referral was investigated. Clinically significant (cs) PCa was defined as Gleason score ≥ 3 + 4. RESULTS: A total of 1575 men were included in the analysis. PCa was diagnosed in 63.2% (996/1575) of men and csPCa in 41.7% (656/1575) of men. Use of the RPCRC-3/4 could have prevented 37.3% (587/1575) of all MRIs within this cohort, thereby missing 18.3% (120/656) of csPCa diagnoses. After recalibration and adjustment of risk thresholds to 20% for PCa and 10% for csPCa, use of the recalibrated RPCRC-3/4 could have prevented 15.1% (238/1575) of all MRIs, resulting in 5.3% (35/656) of csPCa diagnoses being missed. The performance of the RPCRC-MRI was good; use of this risk calculator could have prevented 10.7% (169/1575) of all biopsies, resulting in 1.2% (8/656) of csPCa diagnoses being missed. CONCLUSION: The RPCRC-3/4 underestimates the probability of having csPCa within this Dutch clinical cohort, resulting in significant numbers of csPCa diagnoses being missed. For optimal performance of a risk calculator in a specific cohort, evaluation of its performance within the population under study is essential.
PURPOSE: This study aims to externally validate the Rotterdam Prostate Cancer Risk Calculator (RPCRC)-3/4 and RPCRC-MRI within a Dutch clinical cohort. METHODS: Men subjected to prostate biopsies, between 2018 and 2021, due to a clinical suspicion of prostate cancer (PCa) were retrospectively included. The performance of the RPCRC-3/4 and RPCRC-MRI was analyzed in terms of discrimination, calibration and net benefit. In addition, the need for recalibration and adjustment of risk thresholds for referral was investigated. Clinically significant (cs) PCa was defined as Gleason score ≥ 3 + 4. RESULTS: A total of 1575 men were included in the analysis. PCa was diagnosed in 63.2% (996/1575) of men and csPCa in 41.7% (656/1575) of men. Use of the RPCRC-3/4 could have prevented 37.3% (587/1575) of all MRIs within this cohort, thereby missing 18.3% (120/656) of csPCa diagnoses. After recalibration and adjustment of risk thresholds to 20% for PCa and 10% for csPCa, use of the recalibrated RPCRC-3/4 could have prevented 15.1% (238/1575) of all MRIs, resulting in 5.3% (35/656) of csPCa diagnoses being missed. The performance of the RPCRC-MRI was good; use of this risk calculator could have prevented 10.7% (169/1575) of all biopsies, resulting in 1.2% (8/656) of csPCa diagnoses being missed. CONCLUSION: The RPCRC-3/4 underestimates the probability of having csPCa within this Dutch clinical cohort, resulting in significant numbers of csPCa diagnoses being missed. For optimal performance of a risk calculator in a specific cohort, evaluation of its performance within the population under study is essential.
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