Development and Validation of a Prostate Biopsy Risk Calculator in Black Men

Area of Science:

• Urology
• Oncology
• Biostatistics

Background:

• Prostate cancer (PCa) risk stratification is crucial for biopsy decisions.
• Existing risk calculators may not perform optimally in diverse populations, particularly Black men who have a higher risk of PCa.
• Development of race-specific tools is needed to improve diagnostic accuracy.

Purpose of the Study:

• To develop and validate a novel prostate biopsy risk calculator specifically for Black men.
• To compare the performance of the new calculator against established tools like the Prostate Cancer Prevention Trial version 2.0.
• To evaluate the detection of Gleason Grade Group (GG) ≥ 2 prostate cancer (PCa).

Main Methods:

• Prospective recruitment of two cohorts of Black men undergoing prostate biopsy.
• Development of three risk prediction models using logistic regression, incorporating variables like PSA, digital rectal exam (DRE), and prostate volume.
• Validation of models using C statistics, calibration curves, and net benefit curves at specific risk thresholds.

Main Results:

• Three models (Mistry-Sun 1, 2, and 3) were developed, with C statistics ranging from 0.74 to 0.78.
• The developed models demonstrated comparable or superior performance to existing calculators.
• At 10% and 30% risk thresholds, the new models minimized unnecessary biopsies while appropriately identifying GG ≥ 2 PCa.

Conclusions:

• A tailored risk calculator for Black men can enhance the detection of clinically significant prostate cancer.
• This approach may lead to improved biopsy decision-making and better patient outcomes.
• Race-specific risk stratification is essential for equitable and effective prostate cancer care.