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Clinical Study

Development and validation of a novel risk score for the detection of insignificant prostate cancer in unscreened patient cohorts

  • A Correction to this article was published on 27 February 2019

Abstract

Background

Active surveillance is recommended for insignificant prostate cancer (PCa). Tools exist to identify suitable candidates using clinical variables. We aimed to develop and validate a novel risk score (NRS) predicting which patients are harbouring insignificant PCa.

Methods

We used prospectively collected data from 8040 consecutive unscreened patients who underwent radical prostatectomy between 2006 and 2016. Of these, data from 2799 patients with Gleason 3 + 3 on biopsy were used to develop a multivariate model predicting the presence of insignificant PC at radical prostatectomy (ERSPC updated definition3: Gleason 3 + 3 only, index tumour volume < 1.3 cm3 and total tumour volume < 2.5 cm3). This was used to develop a novel risk score (NRS) which was validated in an equivalent independent cohort (n = 441). We compared the accuracy of existing predictive tools and the NRS in these cohorts.

Results

The NRS (incorporating PSA, prostate volume, age, clinical T Stage, percent and number of positive biopsy cores) outperformed pre-existing predictive tools in derivation and validation cohorts (AUC 0.755 and 0.76, respectively). Selection bias due to analysis of a surgical cohort is acknowledged.

Conclusions

The advantage of the NRS is that it can be tailored to patient characteristics and may prove to be valuable tool in clinical decision-making.

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Data availability

Patient data is stored in the database of the Prostatazentrum Nordwest, St. Antonius-Hospital, Klinik für Urologie, Kinderurologie und Urologische Onkologie, Gronau, Germany.

Change history

  • 27 February 2019

    Since the publication of this paper, the authors noticed that Amar Ahmad was not credited as contributing equally to the paper. He should be considered as a joint first author with Lorenzo Dutto. In addition, the author Ashwin Sridhar was incorrectly listed as Ashwin Shridhar, and the author Gregory L. Shaw was incorrectly listed as Gregory Shaw. The correct names are listed above.

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Author information

Study concept: L.D., A.A. and G.S. Manuscript: L.D. Statistical analysis: A.A. Manuscript revision: J.H.W., J.D.K., S.N. Data handling and interpretation: K.U., A.S., C.W., A.S., M.A., T.P.B. Study coordinators: G.S., J.H.W.

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All patients were consented for collection of data. Full ethical approval for data collection and storage was obtained from the University of Münster, Germany (2015-533-f-S).

Data were collected strictly in accordance with University College London- and Cambridge Hospitals governance policies and in line with the clinical governance processes at the respective institutions.

The study was performed in accordance with the Declaration of Helsinki.

Note

This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0)

Correspondence to Lorenzo Dutto.

Electronic supplementary material

  1. Supplementary Figure 1

  2. Supplementary Table 1

  3. Supplementary Figure 2

  4. Supplementary Table 2

  5. Supplementary Figure 3

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