Comparison of Two Prostate Cancer Risk Calculators that Include the Prostate Health Index

Monique J Roobol; Moniek M Vedder; Daan Nieboer; Alain Houlgatte; Sébastien Vincendeau; Massimo Lazzeri; Giorgio Guazzoni; Carsten Stephan; Axel Semjonow; Alexander Haese; Markus Graefen; Ewout W Steyerberg

doi:10.1016/j.euf.2015.06.004

Comparison of Two Prostate Cancer Risk Calculators that Include the Prostate Health Index

Eur Urol Focus. 2015 Sep;1(2):185-190. doi: 10.1016/j.euf.2015.06.004. Epub 2015 Jun 23.

Authors

Affiliations

¹ Department of Urology, Erasmus MC, Rotterdam, The Netherlands. Electronic address: m.roobol@erasmusmc.nl.
² Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
³ Department of Urology, HIA Du Val De Grace, Paris, France.
⁴ Department of Urology, Hospital Pontchaillou, Rennes, France.
⁵ Department of Urology, San Raffaele Hospital-Turro, Milan, Italy.
⁶ Department of Urology, Charite-Universitaetsmedizin, Berlin, and Berlin Institute for Urologic Research, Berlin, Germany.
⁷ Prostate Centre, Department of Urology, University Hospital Münster, Münster, Germany.
⁸ Prostate Cancer Centre, Martini Clinic, University Hamburg-Eppendorf, Hamburg, Germany.

PMID: 28723432
DOI: 10.1016/j.euf.2015.06.004

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.

Keywords: European Randomized Study of Screening for Prostate Cancer; Lughezzani nomogram; Prostate Health Index; Prostate biopsy; Prostate cancer; Prostate cancer risk calculator; Validation; [–2]Pro–prostate-specific antigen.