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Denijs FB, van Harten MJ, Meenderink JJL, Leenen RCA, Remmers S, Venderbos LDF, van den Bergh RCN, Beyer K, Roobol MJ. Risk calculators for the detection of prostate cancer: a systematic review. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00852-w. [PMID: 38830997 DOI: 10.1038/s41391-024-00852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Prostate cancer (PCa) (early) detection poses significant challenges, including unnecessary testing and the risk of potential overdiagnosis. The European Association of Urology therefore suggests an individual risk-adapted approach, incorporating risk calculators (RCs) into the PCa detection pathway. In the context of 'The PRostate Cancer Awareness and Initiative for Screening in the European Union' (PRAISE-U) project ( https://uroweb.org/praise-u ), we aim to provide an overview of the currently available clinical RCs applicable in an early PCa detection algorithm. METHODS We performed a systematic review to identify RCs predicting detection of clinically significant PCa at biopsy. A search was performed in the databases Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Google Scholar for publications between January 2010 and July 2023. We retrieved relevant literature by using the terms "prostate cancer", "screening/diagnosis" and "predictive model". Inclusion criteria included systematic reviews, meta-analyses, and clinical trials. Exclusion criteria applied to studies involving pre-targeted high-risk populations, diagnosed PCa patients, or a sample sizes under 50 men. RESULTS We identified 6474 articles, of which 140 were included after screening abstracts and full texts. In total, we identified 96 unique RCs. Among these, 45 underwent external validation, with 28 validated in multiple cohorts. Of the externally validated RCs, 17 are based on clinical factors, 19 incorporate clinical factors along with MRI details, 4 were based on blood biomarkers alone or in combination with clinical factors, and 5 included urinary biomarkers. The median AUC of externally validated RCs ranged from 0.63 to 0.93. CONCLUSIONS This systematic review offers an extensive analysis of currently available RCs, their variable utilization, and performance within validation cohorts. RCs have consistently demonstrated their capacity to mitigate the limitations associated with early detection and have been integrated into modern practice and screening trials. Nevertheless, the lack of external validation data raises concerns about numerous RCs, and it is crucial to factor in this omission when evaluating whether a specific RC is applicable to one's target population.
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Affiliation(s)
- Frederique B Denijs
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Meike J van Harten
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonas J L Meenderink
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Renée C A Leenen
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lionne D F Venderbos
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roderick C N van den Bergh
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katharina Beyer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Morote J, Borque-Fernando A, Triquell M, Celma A, Regis L, Escobar M, Mast R, de Torres IM, Semidey ME, Abascal JM, Sola C, Servian P, Salvador D, Santamaría A, Planas J, Esteban LM, Trilla E. The Barcelona Predictive Model of Clinically Significant Prostate Cancer. Cancers (Basel) 2022; 14:cancers14061589. [PMID: 35326740 PMCID: PMC8946272 DOI: 10.3390/cancers14061589] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
A new and externally validated MRI-PM for csPCa was developed in the metropolitan area of Barcelona, and a web-RC designed with the new option of selecting the csPCa probability threshold. The development cohort comprised 1486 men scheduled to undergo a 3-tesla multiparametric MRI (mpMRI) and guided and/or systematic biopsies in one academic institution of Barcelona. The external validation cohort comprised 946 men in whom the same diagnostic approach was carried out as in the development cohort, in two other academic institutions of the same metropolitan area. CsPCa was detected in 36.9% of men in the development cohort and 40.8% in the external validation cohort (p = 0.054). The area under the curve of mpMRI increased from 0.842 to 0.897 in the developed MRI-PM (p < 0.001), and from 0.743 to 0.858 in the external validation cohort (p < 0.001). A selected 15% threshold avoided 40.1% of prostate biopsies and missed 5.4% of the 36.9% csPCa detected in the development cohort. In men with PI-RADS <3, 4.3% would be biopsied and 32.3% of all existing 4.2% of csPCa would be detected. In men with PI-RADS 3, 62% of prostate biopsies would be avoided and 28% of all existing 12.4% of csPCa would be undetected. In men with PI-RADS 4, 4% of prostate biopsies would be avoided and 0.6% of all existing 43.1% of csPCa would be undetected. In men with PI-RADS 5, 0.6% of prostate biopsies would be avoided and none of the existing 42.0% of csPCa would be undetected. The Barcelona MRI-PM presented good performance on the overall population; however, its clinical usefulness varied regarding the PI-RADS category. The selection of csPCa probability thresholds in the designed RC may facilitate external validation and outperformance of MRI-PMs in specific PI-RADS categories.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-9327-46009
| | - Angel Borque-Fernando
- Department of Urology, Hospital Universitario Miguel Servet, IIS-Aragon, 50009 Zaragoza, Spain;
| | - Marina Triquell
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Anna Celma
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Lucas Regis
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Manel Escobar
- Department of Radiology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (M.E.); (R.M.)
| | - Richard Mast
- Department of Radiology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (M.E.); (R.M.)
| | - Inés M. de Torres
- Department of Pathology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (I.M.d.T.); (M.E.S.)
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - María E. Semidey
- Department of Pathology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (I.M.d.T.); (M.E.S.)
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - José M. Abascal
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain; (J.M.A.); (C.S.)
| | - Carles Sola
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain; (J.M.A.); (C.S.)
| | - Pol Servian
- Department of Urology, Hospital Germans Trias I Pujol, 08916 Badalona, Spain; (P.S.); (D.S.)
| | - Daniel Salvador
- Department of Urology, Hospital Germans Trias I Pujol, 08916 Badalona, Spain; (P.S.); (D.S.)
| | - Anna Santamaría
- Urology Research Group, Vall d´ Hebron Research Institute, 08035 Barcelona, Spain;
| | - Jacques Planas
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
| | - Luis M. Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, Universidad de Zaragoza, 50100 Zaragoza, Spain;
| | - Enrique Trilla
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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