title: Selective detection of histologically aggressive prostate cancer: an Early Detection Research Network Prediction model to reduce unnecessary prostate biopsies with validation in the Prostate Cancer Prevention Trial.
abstract: BACKGROUND
  Limited survival benefit and excess treatment because of prostate-specific antigen (PSA) screening in randomized trials suggests a need for more restricted selection of prostate biopsy candidates by discerning risk of histologically aggressive versus indolent cancer before biopsy.
  
  
  METHODS
  Subjects undergoing first prostate biopsy enrolled in a multicenter, prospective cohort of the National Cancer Institute Early Detection Research Network (N = 635) were analyzed to develop a model for predicting histologically aggressive prostate cancers. The control arm of the Prostate Cancer Prevention Trial (N = 3833) was used to validate the generalization of the predictive model.
  
  
  RESULTS
  The Early Detection Research Network cohort was comprised of men among whom 57% had no cancer, 14% had indolent cancer, and 29% had aggressive cancer. Age, body mass index, family history of prostate cancer, abnormal digital rectal examination (DRE), and PSA density (PSAD) were associated with aggressive cancer (all P < .001). The Early Detection Research Network model outperformed PSA alone in predicting aggressive cancer (area under the curve [AUC] = 0.81 vs 0.71, P < .01). Model validation in the Prostate Cancer Prevention Trial cohort accurately identified men at low (<10%) risk of aggressive cancer for whom biopsy could be averted (AUC = 0.78; 95% confidence interval, 0.75-0.80). Under criteria from the Early Detection Research Network model, prostate biopsy can be restricted to men with PSAD >0.1 ng/mL/cc or abnormal DRE. When PSAD is <0.1 ng/mL/cc, family history or obesity can identify biopsy candidates.
  
  
  CONCLUSIONS
  A predictive model incorporating age, family history, obesity, PSAD, and DRE elucidates criteria whereby ¼ of prostate biopsies can be averted while retaining high sensitivity in detecting aggressive prostate cancer.
authors: Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: Stephen B
authors: SB
authors: Williams
authors: Simpa
authors: S
authors: Salami
authors: Meredith M
authors: MM
authors: Regan
authors: Donna P
authors: DP
authors: Ankerst
authors: John T
authors: JT
authors: Wei
authors: Mark A
authors: MA
authors: Rubin
authors: Ian M
authors: IM
authors: Thompson
authors: Martin G
authors: MG
authors: Sanda
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D051517:Digital Rectal Examination; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000517:prevention & control
chemical_list: D017430:Prostate-Specific Antigen