title: European Randomized Study of Screening for Prostate Cancer Risk Calculator: External Validation, Variability, and Clinical Significance.
abstract: OBJECTIVE
  To externally validate the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator (RC) and to evaluate its variability between 2 consecutive prostate-specific antigen (PSA) values.
  
  
  METHODS
  We prospectively catalogued 1021 consecutive patients before prostate biopsy for suspicion of prostate cancer (PCa). The risk of PCa and significant PCa (Gleason score ≥7) from 749 patients was calculated according to ERSPC-RC (digital rectal examination-based version 3 of 4) for 2 consecutive PSA tests per patient. The calculators' predictions were analyzed using calibration plots and the area under the receiver operating characteristic curve (area under the curve). Cohen kappa coefficient was used to compare the ability and variability.
  
  
  RESULTS
  Of 749 patients, PCa was detected in 251 (33.5%) and significant PCa was detected in 133 (17.8%). Calibration plots showed an acceptable parallelism and similar discrimination ability for both PSA levels with an area under the curve of 0.69 for PCa and 0.74 for significant PCa. The ERSPC showed 226 (30.2%) unnecessary biopsies with the loss of 10 significant PCa. The variability of the RC was 16% for PCa and 20% for significant PCa, and a higher variability was associated with a reduced risk of significant PCa.
  
  
  CONCLUSIONS
  We can conclude that the performance of the ERSPC-RC in the present cohort shows a high similitude between the 2 PSA levels; however, the RC variability value is associated with a decreased risk of significant PCa. The use of the ERSPC in our cohort detects a high number of unnecessary biopsies. Thus, the incorporation of ERSPC-RC could help the clinical decision to carry out a prostate biopsy.
authors.affiliation: Urology Department, Reina Sofia University Hospital/IMIBIC/University of Cordoba, Cordoba, Spain. Electronic address: enriquegomezgomez@yahoo.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Gómez
authors.affiliation: Urology Department, Reina Sofia University Hospital/IMIBIC/University of Cordoba, Cordoba, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Carrasco-Valiente
authors.affiliation: IMIBIC/University of Cordoba/Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Blanca-Pedregosa
authors.affiliation: Urology Department, Reina Sofia University Hospital/IMIBIC/University of Cordoba, Cordoba, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Barco-Sánchez
authors.affiliation: Innovation and Analysis Department, IMIBIC/Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Fernandez-Rueda
authors.affiliation: Innovation and Analysis Department, IMIBIC/Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Molina-Abril
authors.affiliation: Urology Department, Reina Sofia University Hospital/IMIBIC/University of Cordoba, Cordoba, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Valero-Rosa
authors.affiliation: Medicine Department, Reina Sofia University Hospital/IMIBIC/University of Cordoba, Cordoba, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Font-Ugalde
authors.affiliation: Urology Department, Reina Sofia University Hospital/IMIBIC/University of Cordoba, Cordoba, Spain.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Requena-Tapia
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer; D005060:Europe; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment