title: The Next Generation of Clinical Decision Making Tools: Development of a Real-Time Prediction Tool for Outcome of Prostate Biopsy in Response to a Continuously Evolving Prostate Cancer Landscape.
abstract: OBJECTIVE
  We evaluate whether annual updating of the PCPT Risk Calculator would improve institutional validation compared to static use of the PCPT Risk Calculator alone.
  
  
  METHODS
  Data from 5 international cohorts including SABOR, Cleveland Clinic, ProtecT, Tyrol and Durham VA, comprising 18,400 biopsies, were used to evaluate an institution specific annual recalibration of the PCPT Risk Calculator. Using all prior years as a training set and the current year as the test set, annual recalibrations of the PCPT Risk Calculator were compared to static use of the PCPT Risk Calculator in terms of AUC and the Hosmer-Lemeshow goodness of fit statistic.
  
  
  RESULTS
  For predicting high grade disease the median AUC (higher is better) of the recalibrated PCPT Risk Calculator (static PCPT Risk Calculator) across all test years for the 5 cohorts was 67.3 (67.5), 65.0 (60.4), 73.4 (73.4), 73.9 (74.1) and 69.6 (67.2), respectively, and median Hosmer-Lemeshow goodness of fit statistics indicated better fit for recalibration compared to the static PCPT Risk Calculator for Cleveland Clinic, ProtecT and the Durham VA but not for SABOR and Tyrol. For predicting overall cancer median AUC was 63.5 (62.7), 61.0 (57.3), 62.1 (62.5), 66.9 (67.3) and 68.5 (65.5), respectively, and median Hosmer-Lemeshow goodness of fit statistics indicated a better fit for recalibration in all cohorts except for Tyrol.
  
  
  CONCLUSIONS
  A simple method has been provided to tailor the PCPT Risk Calculator to individual hospitals to optimize its accuracy for the patient population at hand.
authors: Department of Mathematics, Technical University Munich, Munich, Germany. Electronic address: a.strobl@tum.de.
authors: Andreas N
authors: AN
authors: Strobl
authors: Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Ian M
authors: IM
authors: Thompson
authors: Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Andrew J
authors: AJ
authors: Vickers
authors: Department of Mathematics, Technical University Munich, Munich, Germany; Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Donna P
authors: DP
authors: Ankerst
mesh_terms: D001706:Biopsy; D015331:Cohort Studies; D003199:Computer Systems; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D018570:Risk Assessment; D013997:Time Factors
keywords: biopsy; digital rectal examination; prostate; prostate-specific antigen; risk assessment
references: Urology. 1995 Jan;45(1):70-4
references: 7529449
references: J Urol. 2015 Jan;193(1):95-102
references: 25106900
references: J Natl Cancer Inst. 2006 Apr 19;98(8):529-34
references: 16622122
references: J Clin Epidemiol. 2008 Jan;61(1):76-86
references: 18083464
references: Epidemiol Infect. 2008 Dec;136(12):1628-37
references: 18302806
references: Eur J Cardiovasc Prev Rehabil. 2009 Oct;16(5):562-70
references: 19741542
references: Clin Cancer Res. 2010 Sep 1;16(17):4374-81
references: 20736330
references: Eur Heart J. 2011 Jun;32(11):1316-30
references: 21367834
references: Urology. 2014 Jun;83(6):1362-7
references: 24862395
references: J Biomed Inform. 2012 Feb;45(1):37-44
references: 21907826
references: World J Urol. 2012 Apr;30(2):181-7
references: 22210512
references: Biometrics. 2013 Mar;69(1):206-13
references: 23379600
references: Intensive Care Med. 2013 May;39(5):942-50
references: 23430018
references: Dis Colon Rectum. 2013 Jul;56(7):844-9
references: 23739190
references: J Urol. 2013 Jul;190(1):70-6
references: 23313212
references: J Clin Epidemiol. 2013 Oct;66(10):1158-65
references: 23849738
references: Lancet. 2013 Nov 30;382(9907):1762-5
references: 24268611
references: Intensive Care Med. 2012 Jan;38(1):40-6
references: 22042520
references: N Engl J Med. 2003 Jul 17;349(3):215-24
references: 12824459