Mp46-13 clinical impact of including the 4kscore in the cribriform-updated erspc rotterdam prostate cancer risk calculator predicting clinically significant prostate cancer

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2018MP46-13 CLINICAL IMPACT OF INCLUDING THE 4KSCORE IN THE CRIBRIFORM-UPDATED ERSPC ROTTERDAM PROSTATE CANCER RISK CALCULATOR PREDICTING CLINICALLY SIGNIFICANT PROSTATE CANCER Jan Verbeek, Theodorus van der Kwast, Charlotte Kweldam, Intan Kümmerlin, Geert van Leenders, and Monique Roobol Jan VerbeekJan Verbeek More articles by this author , Theodorus van der KwastTheodorus van der Kwast More articles by this author , Charlotte KweldamCharlotte Kweldam More articles by this author , Intan KümmerlinIntan Kümmerlin More articles by this author , Geert van LeendersGeert van Leenders More articles by this author , and Monique RoobolMonique Roobol More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1472AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Risk calculators to determine a man′s risk for clinically significant prostate cancer (csPCa) at biopsy are known to reduce unnecessary biopsies and overdiagnosis. Updating these tools with advances in research like the use of different growth patterns within Gleason 4 PCa and sub forms of PSA could potentially lead to improved performance. Here we extended the recently developed DRE-based ERSPC Rotterdam Prostate Cancer Risk Calculator including the cribriform growth pattern (RPCRC-cribriform) with the well-known 4Kscore. We assessed clinical impact in terms of reduction of unnecessary biopsies. METHODS The RPCRC-cribriform is based on the latest International Society of Urological Pathology (ISUP) grading system combined with the presence of cribriform growth pattern (CR+) and/or intraductal carcinoma (IDC+) and delivers three probabilities: no cancer, indolent PCa (ISUP grade 1, ISUP grade 2 CR/IDC-), and csPCa (ISUP grade 2 CR/IDC+, ISUP grade ≥3). The 4Kscore combines four kallikrein biomarkers along with patient′s age. We assessed the predictive performance of the RPCRC-cribriform, and the 4Kscore-updated RPCRC-cribriform (4Kscore added as predictor) in a previously published 4Kscore cohort (2872 unscreened men from ERSPC Rotterdam, biopsy indication PSA ≥3.0)1. Decision curve analysis was used to evaluate the number of biopsies avoided between the RPCRC-cribriform nomogram with/without the 4Kscore. RESULTS The 4Kscore-updated RPCRC-cribriform had a higher area under the curve (0.89) than the RPCRC-cribriform (0.87; p<0.01) in csPCa prediction. Decision curve analysis indicated a slight increase in clinical impact for the 4Kscore-updated RPCRC-cribriform model as compared to the RPCRC-cribriform, Figure 1. At a 5% risk csPCa, 4.9 biopsies per 100 men at risk could be avoided by adding 4Kscore next to the RPCRC-cribriform. CONCLUSIONS The performance of the ERSPC Rotterdam risk calculator based on the new ISUP grading for biopsy outcome can be increased further with the addition of the 4Kscore. Gain in net benefit must be weighed against additional costs and availability of tests. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e611 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jan Verbeek More articles by this author Theodorus van der Kwast More articles by this author Charlotte Kweldam More articles by this author Intan Kümmerlin More articles by this author Geert van Leenders More articles by this author Monique Roobol More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...