Prediction of Prostate Cancer Risk: The Role of Prostate Volume and Digital Rectal Examination in the ERSPC Risk Calculators

Erasmus University Medical Centre, Department of Urology, Rotterdam, The Netherlands.
European Urology (Impact Factor: 13.94). 11/2011; 61(3):577-83. DOI: 10.1016/j.eururo.2011.11.012
Source: PubMed


The European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators (RCs) are validated tools for prostate cancer (PCa) risk assessment and include prostate volume (PV) data from transrectal ultrasound (TRUS).
Develop and validate an RC based on digital rectal examination (DRE) that circumvents the need for TRUS but still includes information on PV.
For development of the DRE-based RC, we studied the original ERSPC Rotterdam RC population including 3624 men (885 PCa cases) and 2896 men (547 PCa cases) detected at first and repeat screening 4 yr later, respectively. A validation cohort consisted of 322 men, screened in 2010-2011 as participants in ERSPC Rotterdam.
Data on TRUS-assessed PV in the development cohorts were re-coded into three categories (25, 40, and 60 cm3) to assess the loss of information by categorization of volume information. New RCs including PSA, DRE, and PV categories (DRE-based RC) were developed for men with and without a previous negative biopsy to predict overall and clinically significant PCa (high-grade [HG] PCa) defined as T stage>T2b and/or Gleason score≥7. Predictive accuracy was quantified by the area under the receiver operating curve. We compared performance with the Prostate Cancer Prevention Trial (PCPT) RC in the validation study.
Areas under the curve (AUC) of prostate-specific antigen (PSA) alone, PSA and DRE, the DRE-based RC, and the original ERSPC RC to predict PCa at initial biopsy were 0.69, 0.73, 0.77, and 0.79, respectively. The corresponding AUCs for predicting HG PCa were higher (0.74, 0.82, 0.85, and 0.86). Similar results were seen in men previously biopsied and in the validation cohort. The DRE-based RC outperformed the PCPT RC (AUC 0.69 vs 0.59; p=0.0001) and a model based on PSA and DRE only (AUC 0.69 vs 0.63; p=0.0075) in the relatively small validation cohort. Further validation is required.
An RC should contain volume estimates based either on TRUS or DRE. Replacing TRUS measurements by DRE estimates may enhance implementation in the daily practice of urologists and general practitioners.

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Available from: Monique J Roobol
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    • "Also transrectal ultrasound measurement of prostate volume is prone to be affected by interexaminer variability. Meanwhile, a recent study demonstrated that a new ERSPC risk calculator incorporating prostate volume based upon DRE provided comparable predictive accuracy in predicting significant prostate cancer with transrectal ultrasound-based risk calculator (AUC 0.85 versus 0.86) [71]. Such replacement of transrectal ultrasound measurements with DRE estimates may well enhance the implementation of PSAD as well as prostate volume into risk stratification in clinical setting. "
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    • "The rationale behind this somewhat conservative definition is to avoid misclassification of aggressive PCa do to undersampling on the biopsy, as our results are based on sextant biopsies. Data from our group showed that in men with a screen-detected clinically staged T2a/2b PCa and a biopsy Gleason score <7, the percentage of extracapsular extension (ie, pT3) was approximately 15%, whereas in men with a clinically staged T2c PCa and a biopsy Gleason score <7, this percentage was 26% [13] "
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    • "The ERSPC DRE-based volume calculators were developed on a cohort of 3,624 men who had never before had a biopsy (DREvol-RC3) and a cohort of men (N = 2,896) previously screened/biopsied (DREvol-RC4/5) [11]. The model based on PSA and DRE outcome only was developed on similar cohorts resulting in a model suitable for men previously unscreened (PSADRE-model) and men previously screened and/or biopsied (PSADRE-model, see “Appendix” for formulas). "
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