Optimizing the clinical utility of PCA3 to diagnose prostate cancer in initial prostate biopsy
Rubio-Briones, J. ; Borque Fernando, Ángel (Universidad de Zaragoza) ; Esteban Escaño, Luis Mariano ; Casanova, J. ; Fernandez-Serra, A. ; Rubio, L. ; Casanova-Salas, I. ; Sanz Saiz, Gerardo (Universidad de Zaragoza) ; Domínguez-Escrig, J. ; Collado, A. ; Gómez-Ferrer, A. ; Iborra, I. ; Ramírez-Backhaus, M. ; Martínez, F. ; Calatrava, A. ; Lopez-Guerrero, J.
Resumen: Background: PCA3 has been included in a nomogram outperforming previous clinical models for the prediction of any prostate cancer (PCa) and high grade PCa (HGPCa) at the initial prostate biopsy (IBx). Our objective is to validate such IBx-specific PCA3-based nomogram. We also aim to optimize the use of this nomogram in clinical practice through the definition of risk groups.
Methods: Independent external validation. Clinical and biopsy data from a contemporary cohort of 401 men with the same inclusion criteria to those used to build up the reference’s nomogram in IBx. The predictive value of the nomogram was assessed by means of calibration curves and discrimination ability through the area under the curve (AUC). Clinical utility of the nomogram was analyzed by choosing thresholds points that minimize the overlapping between probability density functions (PDF) in PCa and no PCa and HGPCa and no HGPCa groups, and net benefit was assessed by decision curves.
Results: We detect 28 % of PCa and 11 % of HGPCa in IBx, contrasting to the 46 and 20 % at the reference series. Due to this, there is an overestimation of the nomogram probabilities shown in the calibration curve for PCa. The AUC values are 0.736 for PCa (C.I.95 %:0.68–0.79) and 0.786 for HGPCa (C.I.95 %:0.71–0.87) showing an adequate discrimination ability. PDF show differences in the distributions of nomogram probabilities in PCa and not PCa patient groups. A minimization of the overlapping between these curves confirms the threshold probability of harboring PCa >30 % proposed by Hansen is useful to indicate a IBx, but a cut-off > 40 % could be better in series of opportunistic screening like ours. Similar results appear in HGPCa analysis. The decision curve also shows a net benefit of 6.31 % for the threshold probability of 40 %.
Conclusions: PCA3 is an useful tool to select patients for IBx. Patients with a calculated probability of having PCa over 40 % should be counseled to undergo an IBx if opportunistic screening is required.
Idioma: Inglés
DOI: 10.1186/s12885-015-1623-0
Año: 2015
Publicado en: BMC CANCER 15, 1 (2015), 633 [8 pp]
ISSN: 1471-2407
Factor impacto JCR: 3.265 (2015)
Categ. JCR: ONCOLOGY rank: 85 / 213 = 0.399 (2015) - Q2 - T2
Tipo y forma: Artículo (Versión definitiva)
Área (Departamento): Urología (Departamento de Cirugía, Ginecología y Obstetricia)
Área (Departamento): Estadística e Investigación Operativa (Departamento de Métodos Estadísticos)
Debe reconocer adecuadamente la autoría, proporcionar un enlace a la licencia e indicar si se han realizado cambios. Puede hacerlo de cualquier manera razonable, pero no de una manera que sugiera que tiene el apoyo del licenciador o lo recibe por el uso que hace.
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Methods: Independent external validation. Clinical and biopsy data from a contemporary cohort of 401 men with the same inclusion criteria to those used to build up the reference’s nomogram in IBx. The predictive value of the nomogram was assessed by means of calibration curves and discrimination ability through the area under the curve (AUC). Clinical utility of the nomogram was analyzed by choosing thresholds points that minimize the overlapping between probability density functions (PDF) in PCa and no PCa and HGPCa and no HGPCa groups, and net benefit was assessed by decision curves.
Results: We detect 28 % of PCa and 11 % of HGPCa in IBx, contrasting to the 46 and 20 % at the reference series. Due to this, there is an overestimation of the nomogram probabilities shown in the calibration curve for PCa. The AUC values are 0.736 for PCa (C.I.95 %:0.68–0.79) and 0.786 for HGPCa (C.I.95 %:0.71–0.87) showing an adequate discrimination ability. PDF show differences in the distributions of nomogram probabilities in PCa and not PCa patient groups. A minimization of the overlapping between these curves confirms the threshold probability of harboring PCa >30 % proposed by Hansen is useful to indicate a IBx, but a cut-off > 40 % could be better in series of opportunistic screening like ours. Similar results appear in HGPCa analysis. The decision curve also shows a net benefit of 6.31 % for the threshold probability of 40 %.
Conclusions: PCA3 is an useful tool to select patients for IBx. Patients with a calculated probability of having PCa over 40 % should be counseled to undergo an IBx if opportunistic screening is required.
Idioma: Inglés
DOI: 10.1186/s12885-015-1623-0
Año: 2015
Publicado en: BMC CANCER 15, 1 (2015), 633 [8 pp]
ISSN: 1471-2407
Factor impacto JCR: 3.265 (2015)
Categ. JCR: ONCOLOGY rank: 85 / 213 = 0.399 (2015) - Q2 - T2
Tipo y forma: Artículo (Versión definitiva)
Área (Departamento): Urología (Departamento de Cirugía, Ginecología y Obstetricia)
Área (Departamento): Estadística e Investigación Operativa (Departamento de Métodos Estadísticos)
Debe reconocer adecuadamente la autoría, proporcionar un enlace a la licencia e indicar si se han realizado cambios. Puede hacerlo de cualquier manera razonable, pero no de una manera que sugiera que tiene el apoyo del licenciador o lo recibe por el uso que hace. 0
Exportado de SIDERAL (2016-06-27-10:23:07)
Este artículo se encuentra en las siguientes colecciones:
Artículos > Artículos por área > Estadística e Investigación Operativa
Artículos > Artículos por área > Urología
Registro creado el 2016-01-27, última modificación el 2016-10-06
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