Comparison of risk calculators from the Prostate Cancer Prevention Trial and the European Randomized Study of Screening for Prostate Cancer in a contemporary Canadian cohort

Patients And Methods: At Princess Margaret Hospital, 982 consecutive patients with PCPT-RC and ERSPC-RC covariables were prospectively catalogued before prostate biopsy for suspicion of prostate cancer (PCa). Receiver-operating characteristic (ROC) curves were generated for each calculator and prostate-specific antigen (PSA). Comparisons by area under the curve (AUC) and calibration plots were performed. Predictors of PCa were identified by univariable and multivariable logistic regression. Results: PCa was detected in 46% and high-grade (HG) PCa (Gleason ≥4) in 23% of subjects with a median PSA level of 6.02 ng/mL. Multivariable analysis identified transrectal ultrasonography nodule, prostate volume and PSA as the most important predictors of PCa and HG PCa. ROC curve analysis showed that the ERSPC-RC (AUC = 0.71) outperformed the PCPT-RC (AUC = 0.63) and PSA (AUC = 0.55), for PCa prediction, P < 0.001. The PCPT-RC was better calibrated in the higher prediction range (40-100%) than the ERSPC-RC, whereas the ERSPC-RC had better calibration and avoided more biopsies in the lower risk range (0-30%). Discrimination of the ERSPC-RC continued to be superior to the PCPT-RC when the cohort was stratified by different clinical variables. Conclusions: The ERSPC-RC had better discrimination for predicting PCa compared to the PCPT-RC in this Canadian cohort. Calibration would need to be improved to allow routine use of the ERSPC-RC in Canadian practice. What's known on the subject? and What does the study add? The European Randomized Study of Screening for Prostate Cancer risk calculator (ERSPC-RC) has been validated in a European population and shown to outperform the Prostate Cancer Prevention Trial risk calculator (PCPT-RC) for predicting prostate cancer. However, the ERSPC-RC has not been validated in North America where the PCPT-RC has been extensively validated. This study is the first to compare these calculators in non-European patient cohort showing better performance of the ERSPC-RC, but poor calibration. © 2011 THE AUTHORS. BJU INTERNATIONAL

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