Predictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening. Few studies have compared the performance of both calculators across racial groups. From 1485 prospectively recruited participants, 954 men were identified undergoing initial prostate biopsy for abnormal PSA or digital rectal examination in five Chicago hospitals between 2009 and 2014. Discrimination, calibration, and frequency of avoided biopsies were calculated to assess the performance of both risk calculators. Of 954 participants, 463 (48.5%) were Black, 355 (37.2%) were White, and 136 (14.2%) identified as Other. Biopsy results were as follows: 310 (32.5%) exhibited no cancer, 323 (33.9%) indolent prostate cancer, and 321 (33.6%) clinically significant prostate cancer (csPCa). Differences in area under the curve (AUC)s for the detection of csPCa between PCPT and PBCG were not statistically different across all racial groups. PBCG did not improve calibration plots in Blacks and Others, as it showed higher levels of overprediction at most risk thresholds. PCPT led to an increased number of avoidable biopsies in minorities compared to PBCG at the 30% threshold (68% vs. 28% of all patients) with roughly similar rates of missed csPCa (23% vs. 20%). Significant improvements were noticed in PBCG’s calibrations and net benefits in Whites compared to PCPT. Since PBCG’s improvements in Blacks are disputable and potentially biases a greater number of low risk Black and Other men towards unnecessary biopsies, PCPT may lead to better biopsy decisions in racial minority groups. Further comparisons of commonly used risk calculators across racial groups is warranted to minimize excessive biopsies and overdiagnosis in ethnic minorities.

中文翻译：

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多族群中PBCG与PCPT风险计算器的比较有效性分析

已开发出将种族因素考虑在内的预测模型，例如前列腺癌预防试验风险计算器2.0（PCPT RC）和新的前列腺活检协作组（PBCG）RC，以公平地减轻对前列腺特异性抗原（PSA）筛查的过度诊断。很少有研究比较两个计算器在不同种族群体的表现。在2009年至2014年之间，从1485名预期招募的参与者中，识别出954名男性接受了初步前列腺活检，以进行PSA异常检查或直肠指检，五家芝加哥医院进行了鉴别，校准和避免活检的频率，以评估两种风险计算器的性能。在954位参与者中，有463位（48.5％）是黑人，有355位（37.2％）是白人，有136位（14.2％）被确定为其他。活检结果如下：310（32。5％）未显示癌症，323例（33.9％）惰性前列腺癌和321例（33.6％）临床上显着的前列腺癌（csPCa）。在所有种族中，用于检测csPCa的曲线下面积（AUC）在PCPT和PBCG之间的差异均无统计学差异。PBCG并未改善Blacks and Others中的校准图，因为在大多数风险阈值下，PBCG显示出较高的过度预测水平。与阈值30％的PBCG相比，PCPT导致少数族裔可避免的活检数量增加（68％对28％的所有患者），csPCa漏诊率大致相似（23％对20％）。与PCPT相比，PBCG的校准显着改善，白人获得了净收益。由于PBCG在黑人方面的进步是有争议的，并且可能使更多的低风险黑人和其他男性偏向不必要的活检，因此PCPT可能会导致少数族裔群体做出更好的活检决定。有必要对各个种族之间常用的风险计算器进行进一步比较，以最大程度地减少少数民族的活检和过度诊断。