Purposes

The prostate biopsy collaborative group risk calculator (PBCGRC) is a newly developed risk estimator for predicting prostate biopsy outcomes. However, its clinical usefulness is still unknown within the so-called gray area of PSA values. This study aimed to determine whether updating the PBCGRC improves its predictive performance for predicting any-grade and high-grade (HG), defined as biopsy Gleason score ≥ 7, prostate cancer (PCa) in patients with prostate-specific antigen (PSA) less than 10 ng/ml.

Methods

The risk of any-grade and HGPCa was calculated using the PBCG risk calculation formulas updated by recalibration in the large, logistic recalibration and model revision. Predictive performances of the PBCGRC and the updated models were compared using discrimination, calibration, and clinical utility.

Results

Within the study sample of 526 patients, PCa was detected in 193 (36.7%), and 78 (14.8%) of them had HGPCa. According to the calibration curves, the PBCGRC overestimated the risk of PCa. Predictive accuracy of the revised model was higher [the area under the receiver-operating characteristic curve (AUCs), 65.4% and 70.2%] than that of the PBCGRC (AUCs, 60.4% and 64.3%) for any-grade and HGPCa. The net benefit was greater for model revision in comparison with the original model.

Conclusion

The performance accuracy of PBCGRC for the prediction of any and HGPC in men undergoing prostate biopsy with PSA levels below 10 ng/ml is suboptimal. The model revision resulted with significant improvement in model performance. However, external validation of the revised model is necessary before its routine use in clinical practice.

中文翻译：

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PSA小于10 ng / ml的患者对前列腺活检协作组风险计算器的适应性改善了其性能。

目的

前列腺活检协作组风险计算器（PBCGRC）是一种新开发的风险估算器，用于预测前列腺活检结果。但是，在所谓的PSA值的灰色区域内，其临床用途仍然未知。这项研究旨在确定更新PBCGRC是否能提高其预测任何等级和高等级（HG）的预测性能，定义为活检格里森评分≥7，前列腺特异性抗原（PSA）患者的前列腺癌（PCa）少超过10 ng / ml。

方法

任何级别和HGPCa的风险均使用PBCG风险计算公式来计算，该公式通过在大型Logistic重新校准和模型修订中的重新校准来更新。PBCGRC和更新后的模型的预测性能使用判别，校准和临床实用性进行了比较。

结果

在526例患者的研究样本中，有193例（36.7％）检测到PCa，其中78例（14.8％）患有HGPCa。根据校准曲线，PBCGRC高估了PCa的风险。对于任何等级和HGPCa，修改后的模型的预测准确性更高[接收器工作特征曲线（AUC）下的面积，分别为65.4％和70.2％]，高于PBCGRC的预测准确性（AUC，分别为60.4％和64.3％）。与原始模型相比，模型修订的净收益更大。

结论

PBCGRC预测PSA水平低于10 ng / ml的前列腺穿刺活检男性和HGPC的表现准确性欠佳。模型修订导致模型性能的显着提高。但是，在临床实践中常规使用之前，必须对修订后的模型进行外部验证。