title: Prostate cancer prevention trial and European randomized study of screening for prostate cancer risk calculators: a performance comparison in a contemporary screened cohort.
abstract: BACKGROUND
  Several models can predict the risk of prostate cancer (PCa) on biopsy.
  
  
  OBJECTIVE
  To evaluate the performance of the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators in detecting PCa in a contemporary screened cohort.
  
  
  METHODS
  We analyzed prebiopsy characteristics of 525 consecutive screened patients submitted to biopsy, as required by the risk calculators, in one European center between 2006 and 2007.
  
  
  METHODS
  Comparisons were done using tests of accuracy (area under the receiver operating characteristic curve [AUC-ROC]), calibration plots, and decision curve analysis. Biopsy predictors were identified by univariate and multivariate logistic regression.
  
  
  CONCLUSIONS
  PCa was detected in 35.2% of the subjects. Among predictors included in the calculators, the logarithmic transformations of prostate volume and prostate-specific antigen (PSA), digital rectal examination, previous biopsy status, and age were significantly associated with PCa; transrectal ultrasound abnormalities and family history were not. AUC-ROC for the ERSPC calculator was significantly higher than the PCPT calculator and PSA alone (80.1%, 74.4%, and 64.3%, respectively). Calibration plots showed better performance for the ERSPC calculator; nevertheless, ERSPC may underestimate risk, while PCPT tends to overestimate predictions. Decision curve analysis displayed higher net benefit for the ERSPC calculator; 9% and 23% unnecessary biopsies can be avoided if a threshold probability of 20% and 30%, respectively, is adopted. In contrast, the PCPT model displayed very limited benefit. Our findings apply to a screened European cohort submitted to extended biopsy schemes; consequently, caution should be exerted when considering different populations.
  
  
  CONCLUSIONS
  The ERSPC risk calculator, by incorporating several risks factors, can aid in the estimation of individual PCa risk and in the decision to perform biopsy. The ERSPC calculator outperformed the PCPT model, which is of very limited value, in a contemporary cohort of screened patients.
authors.affiliation: Department of Urology, Centro Hospitalar do Porto, Oporto, Portugal. vcavadas@gmail.com
authors.forename: Vítor
authors.initials: V
authors.lastname: Cavadas
authors.forename: Luís
authors.initials: L
authors.lastname: Osório
authors.forename: Francisco
authors.initials: F
authors.lastname: Sabell
authors.forename: Frederico
authors.initials: F
authors.lastname: Teves
authors.forename: Frederico
authors.initials: F
authors.lastname: Branco
authors.forename: Miguel
authors.initials: M
authors.lastname: Silva-Ramos
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005060:Europe; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment