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Asian Journal of Andrology (2012) 14, 738–744; doi:10.1038/aja.2012.28; published online 7 May 2012
External validation of the Prostate Cancer Prevention Trial and the European Randomized Study of Screening for Prostate Cancer risk calculators in a Chinese cohort
Yao Zhu1,2,*, Jin-You Wang1,2,*, Yi-Jun Shen1,2, Bo Dai1,2, Chun-Guang Ma1,2, Wen-Jun Xiao1,2, Guo-Wen Lin1,2, Xu-Dong Yao1,2, Shi-Lin Zhang and Ding-Wei Ye1,2
1 Department of Urology, Fudan University, Shanghai Cancer Center, Shanghai 200032, China
2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Correspondence: Dr DW Ye, (dwye@shca.org.cn)
* These authors contributed equally to this work.
Received 3 December 2011; Revised 2 January 2012; Accepted 19 February 2012
Advance online publication 7 May 2012.
| Abstract |
Several prediction models have been developed to estimate the outcomes of prostate biopsies. Most of these tools were designed for use with Western populations and have not been validated across different ethnic groups. Therefore, we evaluated the predictive value of the Prostate Cancer Prevention Trial (PCPT) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators in a Chinese cohort. Clinicopathological information was obtained from 495 Chinese men who had undergone extended prostate biopsies between January 2009 and March 2011. The estimated probabilities of prostate cancer and high-grade disease (Gleason >6) were calculated using the PCPT and ERSPC risk calculators. Overall measures, discrimination, calibration and clinical usefulness were assessed for the model evaluation. Of these patients, 28.7% were diagnosed with prostate cancer and 19.4% had high-grade disease. Compared to the PCPT model and the prostate-specific antigen (PSA) threshold of 4 ng ml−1, the ERSPC risk calculator exhibited better discriminative ability for predicting positive biopsies and high-grade disease (the area under the curve was 0.831 and 0.852, respectively, P<0.01 for both). Decision curve analysis also suggested the favourable clinical utility of the ERSPC calculator in the validation dataset. Both prediction models demonstrated miscalibration: the risk of prostate cancer and high-grade disease was overestimated by approximately 20% for a wide range of predicted probabilities. In conclusion, the ERSPC risk calculator outperformed both the PCPT model and the PSA threshold of 4 ng ml−1 in predicting prostate cancer and high-grade disease in Chinese patients. However, the prediction tools derived from Western men significantly overestimated the probability of prostate cancer and high-grade disease compared to the outcomes of biopsies in a Chinese cohort.
Keywords: European Randomized Study of Screening for Prostate Cancer (ERSPC); predictive value of tests; prostate cancer; prostate-specific antigen (PSA); Prostate Cancer Prevention Trial (PCPT) |
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