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External validation of two MRI-based risk calculators in prostate cancer diagnosis

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Background

The diagnosis of (significant) prostate cancer ((s)PC) is impeded by overdiagnosis and unnecessary biopsy. Risk calculators (RC) have been developed to mitigate these issues. Contemporary RCs integrate clinical characteristics with mpMRI findings.

Objective

To validate two of these models—the MRI-ERSPC-RC-3/4 and the risk model of van Leeuwen.

Methods

265 men with clinical suspicion of PC were enrolled. Every patient received a prebiopsy mpMRI, which was reported according to PI-RADS v2.1, followed by MRI/TRUS fusion-biopsy. Cancers with ISUP grade ≥ 2 were classified as sPC.

Outcome measurements and statistical analysis

Statistical analysis was performed by comparing discrimination, calibration, and clinical utility

Results

There was no significant difference in discrimination between the RCs. The MRI-ERSPC-RC-3/4-RC showed a nearly ideal calibration-slope (0.94; 95% CI 0.68–1.20) than the van Leeuwen model (0.70; 95% CI 0.52–0.88). Within a threshold range up to 9% for a sPC, the MRI-ERSPC-RC-3/4-RC shows a greater net benefit than the van Leeuwen model. From 10 to 15%, the van Leeuwen model showed a higher net benefit compared to the MRI-ERSP-3/4-RC. For a risk threshold of 15%, the van Leeuwen model would avoid 24% vs. 14% compared to the MRI-ERSPC-RC-3/4 model; 6% vs. 5% sPC would be overlooked, respectively.

Conclusion

Both risk models supply accurate results and reduce the number of biopsies and basically no sPC were overlooked. The van Leeuwen model suggests a better balance between unnecessary biopsies and overlooked sPC at thresholds range of 10–15%. The MRI-ERSPC-RC-3/4 risk model provides better overall calibration.

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Acknowledgements

We thank Monique J. Roobol for critically reviewing the study design and manuscript. We thank the Else Kröner-Fresenius-Foundation for sustaining the prostate cancer research group at Paracelsus Medical University Nuremberg.

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Authors and Affiliations

  1. Department of Urology, Paracelsus Medical University Nuremberg, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany

    Anna-Lena Petersmann, Tilman Klein, Clemens Huettenbrink, Sascha A. Pahernik & Florian A. Distler

  2. Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Sebastiaan Remmers

  3. Institute of Radiology and Nuclear Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany

    Panagiota Manava

Authors
  1. Anna-Lena Petersmann
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  2. Sebastiaan Remmers
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  4. Panagiota Manava
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  5. Clemens Huettenbrink
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  6. Sascha A. Pahernik
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  7. Florian A. Distler
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Contributions

A-LP—data collection and manuscript writing. SR—data analyses and manuscript editing. TK—data collection and manuscript editing. PM—manuscript editing. CH—data collection and manuscript editing. SAP—data collection and manuscript editing. FAD—project development, data collection and management, data analyses, and manuscript editing.

Corresponding author

Correspondence to Florian A. Distler.

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All authors have no conflict of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Petersmann, AL., Remmers, S., Klein, T. et al. External validation of two MRI-based risk calculators in prostate cancer diagnosis. World J Urol 39, 4109–4116 (2021). https://doi.org/10.1007/s00345-021-03770-x

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  • DOI: https://doi.org/10.1007/s00345-021-03770-x

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