Development and Validation of a Prostate Biopsy Risk Calculator in Black Men

Open AccessJournal of UrologyAdult Urology2 Nov 2023Development and Validation of a Prostate Biopsy Risk Calculator in Black Men Neil A. Mistry, Zequn Sun, Jamila Sweis, Cordero McCall, Norma Marshall, Bernice Ofori, Courtney M. P. Hollowell, Rick A. Kittles, Edward M. Schaeffer, Michael Abern, Peter Gann, and Adam B. Murphy Neil A. MistryNeil A. Mistry Department of Urology, Northwestern University Feinberg School of Medicine , Zequn SunZequn Sun Department of Preventive Medicine and Biostatistics, Northwestern University Feinberg School of Medicine , Jamila SweisJamila Sweis Department of Urology, Northwestern University Feinberg School of Medicine , Cordero McCallCordero McCall Medical College of Wisconsin, Milwaukee, Wisconsin , Norma MarshallNorma Marshall Department of Urology, Northwestern University Feinberg School of Medicine , Bernice OforiBernice Ofori Department of Urology, Northwestern University Feinberg School of Medicine , Courtney M. P. HollowellCourtney M. P. Hollowell Department of Urology, Cook County Hospital, Chicago, Illinois , Rick A. KittlesRick A. Kittles Morehouse School of Medicine, Atlanta, Georgia , Edward M. SchaefferEdward M. Schaeffer Department of Urology, Northwestern University Feinberg School of Medicine , Michael AbernMichael Abern Department of Urology, University of Illinois at Chicago, Chicago, Illinois , Peter GannPeter Gann Department of Pathology, University of Illinois at Chicago, Chicago, Illinois , and Adam B. MurphyAdam B. Murphy *Correspondence: (email: E-mail Address: [email protected]). https://orcid.org/0000-0001-9977-3473 Department of Urology, Northwestern University Feinberg School of Medicine Department of Urology, Cook County Hospital, Chicago, Illinois View All Author Informationhttps://doi.org/10.1097/JU.0000000000003774AboutPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: To develop and validate a prostate biopsy risk calculator for Black men and compare it with the Prostate Cancer Prevention Trial version 2.0 (PCPT), Prostate Biopsy Collaborative Group (PBCG), and Kaiser Permanente Prostate Cancer (Kaiser) Risk Calculators for the detection of Gleason Grade Group (GG) ≥2 prostate cancer (PCa). Materials and Methods: We prospectively recruited 2 cohorts of men undergoing prostate biopsy from 5 facilities in Chicago. The first cohort was split into development (70%) and internal validation (30%) groups. The second was used for external validation. Iterative logistic regression was used to develop 3 models for predicting GG ≥ 2 PCa. Models were compared for discrimination using the c-statistics, calibration curves and net benefit curves. The frequency of unnecessary biopsies and missed PCas was compared at 10% and 30% risk thresholds. Results: The 2 cohorts included 393 and 292 Black men, respectively. Our first model, Mistry-Sun1, used serum prostate-specific antigen (PSA) and prior negative biopsy. Mistry-Sun2 added abnormal digital rectal exam (DRE) and an interaction term with abnormal DRE and PSA to Mistry-Sun1. Mistry-Sun3 added prostate volume, abnormal DRE, and age to Mistry-Sun1. The c-statistics were 0.74, 0.74, and 0.78, respectively, and were similar to or higher than established calculators. At the 10% and 30% risk-thresholds our models had the fewest unnecessary biopsies and an appropriate proportion of missed GG ≥ 2 PCas. Conclusion: Tailoring a risk calculator to detect clinically significant PCa in Black men may improve biopsy decision-making and outcomes compared to tools developed in non-Black populations. Funding: W81XWH-17-0608, T37 MD014248, W81XWH-21-1-0850. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.© 2023 The Author(s). Published on behalf of the American Urological Association, Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2023 The Author(s). Published on behalf of the American Urological Association, Education and Research, Inc.KeywordsRisk predictionProstate biopsyDisparitiesRisk calculatorProstate cancerMetrics Author Information Neil A. Mistry Department of Urology, Northwestern University Feinberg School of Medicine Contributed equally. More articles by this author Zequn Sun Department of Preventive Medicine and Biostatistics, Northwestern University Feinberg School of Medicine Contributed equally. More articles by this author Jamila Sweis Department of Urology, Northwestern University Feinberg School of Medicine More articles by this author Cordero McCall Medical College of Wisconsin, Milwaukee, Wisconsin More articles by this author Norma Marshall Department of Urology, Northwestern University Feinberg School of Medicine More articles by this author Bernice Ofori Department of Urology, Northwestern University Feinberg School of Medicine More articles by this author Courtney M. P. Hollowell Department of Urology, Cook County Hospital, Chicago, Illinois More articles by this author Rick A. Kittles Morehouse School of Medicine, Atlanta, Georgia More articles by this author Edward M. Schaeffer Department of Urology, Northwestern University Feinberg School of Medicine More articles by this author Michael Abern Department of Urology, University of Illinois at Chicago, Chicago, Illinois More articles by this author Peter Gann Department of Pathology, University of Illinois at Chicago, Chicago, Illinois More articles by this author Adam B. Murphy Department of Urology, Northwestern University Feinberg School of Medicine Department of Urology, Cook County Hospital, Chicago, Illinois *Correspondence: (email: E-mail Address: [email protected]). More articles by this author Expand All Funding: W81XWH-17-0608, T37 MD014248, W81XWH-21-1-0850. Advertisement PDF downloadLoading ...