Comparative Performance of Prostate Cancer Risk Prediction Tools in Gay, Bisexual, and Other Men Who Have Sex With...

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Men who have sex with men (MSM) are underrepresented in prostate cancer (PCa) risk tool validation studies.
• Factors like behavior and anatomy may affect the performance of PSA, DRE, and MRI in PCa risk assessment.
• Understanding PCa risk in diverse populations is crucial for accurate diagnosis.

Purpose of the Study:

• To compare the accuracy of clinical and MRI-based PCa risk calculators between MSM and heterosexual men (HSM).
• To evaluate the performance of specific risk calculators (PLUM, UCLA, My nMRIsk) in different sexual orientation groups.
• To determine if current PCa risk tools require recalibration for MSM.

Main Methods:

• Analysis of 486 men (243 MSM, 243 HSM) undergoing prostate biopsy, matched for key demographic and clinical factors.
• Extraction and validation of sexual orientation, demographics, imaging, lab data, DRE, and biopsy results from electronic health records.
• Logistic regression models and AUC, calibration, and decision-curve analyses were used to evaluate risk calculator predictions.

Main Results:

• MSM and HSM groups were similar in age, PSA, prostate volume, and PI-RADS distribution.
• Abnormal digital rectal examination (DRE) was more frequent in MSM but not linked to higher risk of clinically significant PCa (csPCa).
• MRI-based calculators showed higher AUCs in MSM, with PLUM and UCLA performing best.

Conclusions:

• MRI-based risk calculators demonstrate superior diagnostic accuracy in MSM compared to HSM.
• Current prostate cancer risk assessment tools are suitable for use in MSM without the need for recalibration.
• These findings support the reliable application of advanced risk stratification tools across diverse patient populations.