Magnetic resonance imaging (MRI) is a promising tool for risk assessment, potentially reducing the burden of unnecessary prostate biopsies. Risk prediction models that incorporate MRI data have gained attention, but their external validation and comparison are essential for guiding clinical practice. The aim is to externally validate and compare risk prediction models for the diagnosis of clinically significant prostate cancer (csPCa).
A cohort of 4606 patients across fifteen European tertiary referral centers were identified from a prospective maintained database between January 2016 and April 2023. Transrectal or transperineal image-fusion MRI-targeted and systematic biopsies for PI-RADS score of ≥ 3 or ≥ 2 depending on patient characteristics and physician preferences. Probabilities for csPCa, defined as International Society of Urological Pathology (ISUP) grade ≥ 2, were calculated for each patients using eight models. Performance was characterized by area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Subgroup analyses were performed across various clinically relevant subgroups.
Overall, csPCa was detected in 2154 (47%) patients. The models exhibited satisfactory performance, demonstrating good discrimination (AUC ranging from 0.75 to 0.78, p < 0.001), adequate calibration, and high net benefit. The model described by Alberts showed the highest clinical utility for threshold probabilities between 10 and 20%. Subgroup analyses highlighted variations in models' performance, particularly when stratified according to PSA level, biopsy technique and PI-RADS version.
We report a comprehensive external validation of risk prediction models for csPCa diagnosis in patients who underwent MRI-targeted and systematic biopsies. The model by Alberts demonstrated superior clinical utility and should be favored when determining the need for a prostate biopsy.
World journal of urology. 2024 Jun 12*** epublish ***
Romain Diamand, Karsten Guenzel, Teddy Jabbour, Arthur Baudewyns, Henri-Alexandre Bourgeno, Yolène Lefebvre, Mariaconsiglia Ferriero, Giuseppe Simone, Alexandre Fourcade, Georges Fournier, Alexandre Patrick Bui, Fayek Taha, Marco Oderda, Paolo Gontero, Katerina Rysankova, Adrian Bernal-Gomez, Alessandro Mastrorosa, Jean-Baptiste Roche, Gaelle Fiard, Rawad Abou Zahr, Guillaume Ploussard, Olivier Windisch, Quentin Novello, Daniel Benamran, Gina Delavar, Julien Anract, Nicolas Barry Delongchamps, Adam Halinski, Charles Dariane, Léonidas Vlahopoulos, Gregoire Assenmacher, Thierry Roumeguère, Alexandre Peltier
Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Jules Bordet Institute, HUB, Rue Meylemeersch 90, 1070, Brussels, Belgium. ., Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany., Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Jules Bordet Institute, HUB, Rue Meylemeersch 90, 1070, Brussels, Belgium., Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France., Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France., Department of Urology, Città Della Salute E Della Scienza Di Torino, University of Turin, Turin, Italy., Department of Urology and Surgical Studies, Faculty of Medicine, University Hospital Ostrava, Ostrava University, Ostrava, Czech Republic., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France., Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France., Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland., Departement of Urology, Hôpital Cochin, Paris, France., Department of Urology, Private Medical Center, Klinika Wisniowa", Zielona Góra, Poland., Department of Urology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France., Department of Urology, Cliniques de L'Europe-Saint Elisabeth, Brussels, Belgium.