Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculator for Initial Prostate Biopsy by Incorporating the 2014 International Society of Urological Pathology Gleason Grading and Cribriform growth

• Published in: European urology 2017-07, Vol.72 (1), p.45-51
• Main Authors: Roobol, Monique J, Verbeek, Jan F.M, van der Kwast, Theo, Kümmerlin, Intan P, Kweldam, Charlotte F, van Leenders, Geert J.L.H
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Aged; Area Under Curve; Biopsy; Carcinoma, Intraductal, Noninfiltrating - mortality; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - therapy; Clinical Decision-Making; Cribriform; Decision Support Techniques; Humans; International Society of Urological Pathology grading system; Intraductal carcinoma; Logistic Models; Male; Middle Aged; Mobile Applications; Multivariate Analysis; Neoplasm Grading; Patient Selection; Prediction model; Predictive Value of Tests; Prognosis; Prostate cancer; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - therapy; Reproducibility of Results; Risk Assessment; Risk calculator; Risk Factors; ROC Curve; Time Factors; Treatment Outcome; Unnecessary Procedures; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2017.01.033

Abstract Background The survival rate for men with International Society of Urological Pathology (ISUP) grade 2 prostate cancer (PCa) without invasive cribriform (CR) and intraductal carcinoma (IDC) is similar to that for ISUP grade 1. If updated into the European Randomized Study of Screening for Prostate Cancer (ERSPC Rotterdam) risk calculator number 3 (RC3), this may further improve upfront selection of men who need a biopsy. Objective To improve the number of possible biopsies avoided, while limiting undiagnosed clinically important PCa by applying the updated RC3 for risk-based patient selection. Design, setting, and participants The RC3 is based on the first screening round of the ERSPC Rotterdam, which involved 3616 men. In 2015, histopathologic slides for PCa cases ( n = 885) were re-evaluated. Low-risk (LR) PCa was defined as ISUP grade 1 or 2 without CR/IDC. High-risk (HR) PCa was defined as ISUP grade 2 with CR/IDC and PCa with ISUP grade≥3. Outcome measurements and statistical analysis We updated the RC3 using multinomial logistic regression analysis, including data on age, PSA, digital rectal examination, and prostate volume, for predicting LR and HR PCa. Predictive accuracy was quantified using receiver operating characteristic analysis and decision curve analysis. Results and limitations Men without PCa could effectively be distinguished from men with LR PCa and HR PCa (area under the curve 0.70, 95% confidence interval [CI] 0.68–0.72 and 0.92, 95% CI 0.90–0.94). At a 1% risk threshold, the updated calculator would lead to a 34% reduction in unnecessary biopsies, while only 2% of HR PCa cases would be undiagnosed. Conclusions A relatively simple risk stratification tool augmented with a highly sensitive contemporary pathologic biopsy classification would result in a considerable decrease in unnecessary prostate biopsies and overdiagnosis of potentially indolent disease. Patient summary We improved a well-known prostate risk calculator with a new pathology classification system that better reflects disease burden. This new risk calculator allows individualized prediction of the chance of having (potentially aggressive) biopsy-detectable prostate cancer and can guide shared decision-making when considering prostate biopsy.