Importance of prostate volume in the European Randomised Study of Screening for Prostate Cancer (ERSPC) risk calculators: results from the prostate biopsy collaborative group.
OBJECTIVE
To compare the predictive performance and potential clinical usefulness of risk calculators of the European Randomized Study of Screening for Prostate Cancer (ERSPC RC) with and without information on prostate volume.


METHODS
We studied 6 cohorts (5 European and 1 US) with a total of 15,300 men, all biopsied and with pre-biopsy TRUS measurements of prostate volume. Volume was categorized into 3 categories (25, 40, and 60 cc), to reflect use of digital rectal examination (DRE) for volume assessment. Risks of prostate cancer were calculated according to a ERSPC DRE-based RC (including PSA, DRE, prior biopsy, and prostate volume) and a PSA + DRE model (including PSA, DRE, and prior biopsy). Missing data on prostate volume were completed by single imputation. Risk predictions were evaluated with respect to calibration (graphically), discrimination (AUC curve), and clinical usefulness (net benefit, graphically assessed in decision curves).


RESULTS
The AUCs of the ERSPC DRE-based RC ranged from 0.61 to 0.77 and were substantially larger than the AUCs of a model based on only PSA + DRE (ranging from 0.56 to 0.72) in each of the 6 cohorts. The ERSPC DRE-based RC provided net benefit over performing a prostate biopsy on the basis of PSA and DRE outcome in five of the six cohorts.


CONCLUSIONS
Identifying men at increased risk for having a biopsy detectable prostate cancer should consider multiple factors, including an estimate of prostate volume.
Department of Urology, Erasmus University Medical Centre, P.O Box 2010, 3000 CA, Rotterdam, The Netherlands. m.roobol@erasmusmc.nl
Monique J
MJ
Roobol
F H
FH
Schröder
Jonas
J
Hugosson
J Stephen
JS
Jones
Michael W
MW
Kattan
Eric A
EA
Klein
Freddie
F
Hamdy
David
D
Neal
Jenny
J
Donovan
Dipen J
DJ
Parekh
Donna
D
Ankerst
George
G
Bartsch
Helmut
H
Klocker
Wolfgang
W
Horninger
Amine
A
Benchikh
Gilles
G
Salama
Arnauld
A
Villers
Stephen J
SJ
Freedland
Daniel M
DM
Moreira
Andrew J
AJ
Vickers
Hans
H
Lilja
Ewout W
EW
Steyerberg
D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D051517:Digital Rectal Examination; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011467:Prostate / Q000033:anatomy & histology* / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D012306:Risk; D018570:Risk Assessment
D017430:Prostate-Specific Antigen