Adding a Coefficient for Race to the 4Kscore Improves Calibration for Black Men

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Black men exhibit a higher incidence of high-risk prostate cancer (PCa) compared to non-Black men.
• The 4Kscore is a validated tool for PCa risk stratification but does not currently incorporate racial factors.

Purpose of the Study:

• To describe and validate a prespecified race coefficient for the 4Kscore.
• To enhance the accuracy of the 4Kscore for Black men.

Main Methods:

• A race coefficient of 0.6 was prespecified using data from 85 Black men.
• The 4Kscore's discrimination, calibration, and clinical utility were evaluated with and without the coefficient in a cohort of 205 Black men.
• Sensitivity analysis was performed on a combined cohort.

Main Results:

• The mean probability of high-grade PCa increased from 25% to 37% with the race coefficient.
• Incorporating the coefficient improved 4Kscore calibration and clinical utility in Black men.
• Model discrimination remained stable (AUC 0.825 vs 0.828) in the combined cohort.

Conclusions:

• A prespecified coefficient for Black race enhances the 4Kscore's calibration and clinical utility.
• The addition of this race coefficient is recommended for improved prostate cancer risk assessment in Black men.