The European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator has been adapted for a Chinese population and shows excellent discrimination, according to a study published in Prostate Cancer and Prostatic Diseases.
The ERSPC was set up to investigate the effect of PSA screening on prostate cancer mortality and recently reported a 21% decrease in prostate cancer mortality at the 13-year follow-up point. The risk calculator associated with the ERSPC (RC3) has previously been shown to perform well in a number of different settings, but a risk calculator specifically for the Chinese population is lacking.
Chiu et al. identified 5,165 Hong Kong Chinese men from a database of transrectal ultrasonography (TRUS)-guided biopsies performed at a tertiary centre as the development cohort. 3,006 consecutive patients from this group aged 50–80 years, who had initial biopsies, serum PSA levels 0.4–50 ng/ml (WHO calibration), and TRUS prostate volume (TRUS-PV) 10–150 ml, were then included for validation of the original ERSPC RC3. 16.7% and 7.8% of men in the developmental cohort were diagnosed with prostate cancer and high-grade prostate cancer, respectively. In the validation cohort, 20.2% were diagnosed with prostate cancer and 9.7% with high-grade prostate cancer. Application of ERSPC RC3 for prostate cancer and high-grade prostate cancer to the development cohort produced AUCs of 0.75 (95% CI 0.73–0.78) and 0.84 (95% CI 0.81–0.87), respectively. However, the calculator overestimated positive biopsy rates by 10–40% for prostate cancer and 10–30% for high-grade prostate cancer. Recalibration of the models and testing in a second validation cohort produced AUCs of 0.76 (95% CI 0.73–0.79) and 0.85 (95% CI 0.82–0.87) for prostate cancer and high-grade prostate cancer, respectively, indicating that significant proportions of prostate biopsies could have been avoided by using the recalibrated RC3 in this Chinese population.
References
Chiu, P. K. et al. Adaptation and external validation of the European randomised study of screening for prostate cancer risk calculator for the Chinese population. Prostate Cancer Prostatic Dis. http://dx.doi.org/10.1038/pcan.2016.57 (2016)
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Fenner, A. ERSPC calculator recalibrated for China. Nat Rev Urol 14, 66 (2017). https://doi.org/10.1038/nrurol.2016.259
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DOI: https://doi.org/10.1038/nrurol.2016.259
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