A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort

Samuel Carbunaru, Oluwarotimi S. Nettey, Pooja Gogana, Irene B. Helenowski, Borko Jovanovic, Maria Ruden, Courtney M.P. Hollowell, Roohollah Sharifi, Rick A. Kittles, Edward Schaeffer, Peter Gann, Adam B. Murphy*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Predictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening. Few studies have compared the performance of both calculators across racial groups. Methods: From 1485 prospectively recruited participants, 954 men were identified undergoing initial prostate biopsy for abnormal PSA or digital rectal examination in five Chicago hospitals between 2009 and 2014. Discrimination, calibration, and frequency of avoided biopsies were calculated to assess the performance of both risk calculators. Results: Of 954 participants, 463 (48.5%) were Black, 355 (37.2%) were White, and 136 (14.2%) identified as Other. Biopsy results were as follows: 310 (32.5%) exhibited no cancer, 323 (33.9%) indolent prostate cancer, and 321 (33.6%) clinically significant prostate cancer (csPCa). Differences in area under the curve (AUC)s for the detection of csPCa between PCPT and PBCG were not statistically different across all racial groups. PBCG did not improve calibration plots in Blacks and Others, as it showed higher levels of overprediction at most risk thresholds. PCPT led to an increased number of avoidable biopsies in minorities compared to PBCG at the 30% threshold (68% vs. 28% of all patients) with roughly similar rates of missed csPCa (23% vs. 20%). Conclusion: Significant improvements were noticed in PBCG's calibrations and net benefits in Whites compared to PCPT. Since PBCG's improvements in Blacks are disputable and potentially biases a greater number of low risk Black and Other men towards unnecessary biopsies, PCPT may lead to better biopsy decisions in racial minority groups. Further comparisons of commonly used risk calculators across racial groups is warranted to minimize excessive biopsies and overdiagnosis in ethnic minorities.

Original languageEnglish (US)
Article number121
JournalBMC Urology
Volume19
Issue number1
DOIs
StatePublished - Nov 27 2019

Fingerprint

Prostate
Biopsy
Prostatic Neoplasms
Calibration
Prostate-Specific Antigen
Digital Rectal Examination
Minority Groups
Area Under Curve

Keywords

  • African American validation
  • Prostate Cancer prevention trial risk calculator 2.0
  • Prostate biopsy collaborative group risk calculator
  • Prostate cancer risk prediction
  • Risk calculator

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology

Cite this

Carbunaru, Samuel ; Nettey, Oluwarotimi S. ; Gogana, Pooja ; Helenowski, Irene B. ; Jovanovic, Borko ; Ruden, Maria ; Hollowell, Courtney M.P. ; Sharifi, Roohollah ; Kittles, Rick A. ; Schaeffer, Edward ; Gann, Peter ; Murphy, Adam B. / A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort. In: BMC Urology. 2019 ; Vol. 19, No. 1.
@article{e93facf3d14c4ad7a9e6f657338a39fb,
title = "A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort",
abstract = "Background: Predictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening. Few studies have compared the performance of both calculators across racial groups. Methods: From 1485 prospectively recruited participants, 954 men were identified undergoing initial prostate biopsy for abnormal PSA or digital rectal examination in five Chicago hospitals between 2009 and 2014. Discrimination, calibration, and frequency of avoided biopsies were calculated to assess the performance of both risk calculators. Results: Of 954 participants, 463 (48.5{\%}) were Black, 355 (37.2{\%}) were White, and 136 (14.2{\%}) identified as Other. Biopsy results were as follows: 310 (32.5{\%}) exhibited no cancer, 323 (33.9{\%}) indolent prostate cancer, and 321 (33.6{\%}) clinically significant prostate cancer (csPCa). Differences in area under the curve (AUC)s for the detection of csPCa between PCPT and PBCG were not statistically different across all racial groups. PBCG did not improve calibration plots in Blacks and Others, as it showed higher levels of overprediction at most risk thresholds. PCPT led to an increased number of avoidable biopsies in minorities compared to PBCG at the 30{\%} threshold (68{\%} vs. 28{\%} of all patients) with roughly similar rates of missed csPCa (23{\%} vs. 20{\%}). Conclusion: Significant improvements were noticed in PBCG's calibrations and net benefits in Whites compared to PCPT. Since PBCG's improvements in Blacks are disputable and potentially biases a greater number of low risk Black and Other men towards unnecessary biopsies, PCPT may lead to better biopsy decisions in racial minority groups. Further comparisons of commonly used risk calculators across racial groups is warranted to minimize excessive biopsies and overdiagnosis in ethnic minorities.",
keywords = "African American validation, Prostate Cancer prevention trial risk calculator 2.0, Prostate biopsy collaborative group risk calculator, Prostate cancer risk prediction, Risk calculator",
author = "Samuel Carbunaru and Nettey, {Oluwarotimi S.} and Pooja Gogana and Helenowski, {Irene B.} and Borko Jovanovic and Maria Ruden and Hollowell, {Courtney M.P.} and Roohollah Sharifi and Kittles, {Rick A.} and Edward Schaeffer and Peter Gann and Murphy, {Adam B.}",
year = "2019",
month = "11",
day = "27",
doi = "10.1186/s12894-019-0553-6",
language = "English (US)",
volume = "19",
journal = "BMC Urology",
issn = "1471-2490",
publisher = "BioMed Central",
number = "1",

}

A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort. / Carbunaru, Samuel; Nettey, Oluwarotimi S.; Gogana, Pooja; Helenowski, Irene B.; Jovanovic, Borko; Ruden, Maria; Hollowell, Courtney M.P.; Sharifi, Roohollah; Kittles, Rick A.; Schaeffer, Edward; Gann, Peter; Murphy, Adam B.

In: BMC Urology, Vol. 19, No. 1, 121, 27.11.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort

AU - Carbunaru, Samuel

AU - Nettey, Oluwarotimi S.

AU - Gogana, Pooja

AU - Helenowski, Irene B.

AU - Jovanovic, Borko

AU - Ruden, Maria

AU - Hollowell, Courtney M.P.

AU - Sharifi, Roohollah

AU - Kittles, Rick A.

AU - Schaeffer, Edward

AU - Gann, Peter

AU - Murphy, Adam B.

PY - 2019/11/27

Y1 - 2019/11/27

N2 - Background: Predictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening. Few studies have compared the performance of both calculators across racial groups. Methods: From 1485 prospectively recruited participants, 954 men were identified undergoing initial prostate biopsy for abnormal PSA or digital rectal examination in five Chicago hospitals between 2009 and 2014. Discrimination, calibration, and frequency of avoided biopsies were calculated to assess the performance of both risk calculators. Results: Of 954 participants, 463 (48.5%) were Black, 355 (37.2%) were White, and 136 (14.2%) identified as Other. Biopsy results were as follows: 310 (32.5%) exhibited no cancer, 323 (33.9%) indolent prostate cancer, and 321 (33.6%) clinically significant prostate cancer (csPCa). Differences in area under the curve (AUC)s for the detection of csPCa between PCPT and PBCG were not statistically different across all racial groups. PBCG did not improve calibration plots in Blacks and Others, as it showed higher levels of overprediction at most risk thresholds. PCPT led to an increased number of avoidable biopsies in minorities compared to PBCG at the 30% threshold (68% vs. 28% of all patients) with roughly similar rates of missed csPCa (23% vs. 20%). Conclusion: Significant improvements were noticed in PBCG's calibrations and net benefits in Whites compared to PCPT. Since PBCG's improvements in Blacks are disputable and potentially biases a greater number of low risk Black and Other men towards unnecessary biopsies, PCPT may lead to better biopsy decisions in racial minority groups. Further comparisons of commonly used risk calculators across racial groups is warranted to minimize excessive biopsies and overdiagnosis in ethnic minorities.

AB - Background: Predictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening. Few studies have compared the performance of both calculators across racial groups. Methods: From 1485 prospectively recruited participants, 954 men were identified undergoing initial prostate biopsy for abnormal PSA or digital rectal examination in five Chicago hospitals between 2009 and 2014. Discrimination, calibration, and frequency of avoided biopsies were calculated to assess the performance of both risk calculators. Results: Of 954 participants, 463 (48.5%) were Black, 355 (37.2%) were White, and 136 (14.2%) identified as Other. Biopsy results were as follows: 310 (32.5%) exhibited no cancer, 323 (33.9%) indolent prostate cancer, and 321 (33.6%) clinically significant prostate cancer (csPCa). Differences in area under the curve (AUC)s for the detection of csPCa between PCPT and PBCG were not statistically different across all racial groups. PBCG did not improve calibration plots in Blacks and Others, as it showed higher levels of overprediction at most risk thresholds. PCPT led to an increased number of avoidable biopsies in minorities compared to PBCG at the 30% threshold (68% vs. 28% of all patients) with roughly similar rates of missed csPCa (23% vs. 20%). Conclusion: Significant improvements were noticed in PBCG's calibrations and net benefits in Whites compared to PCPT. Since PBCG's improvements in Blacks are disputable and potentially biases a greater number of low risk Black and Other men towards unnecessary biopsies, PCPT may lead to better biopsy decisions in racial minority groups. Further comparisons of commonly used risk calculators across racial groups is warranted to minimize excessive biopsies and overdiagnosis in ethnic minorities.

KW - African American validation

KW - Prostate Cancer prevention trial risk calculator 2.0

KW - Prostate biopsy collaborative group risk calculator

KW - Prostate cancer risk prediction

KW - Risk calculator

UR - http://www.scopus.com/inward/record.url?scp=85075664347&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075664347&partnerID=8YFLogxK

U2 - 10.1186/s12894-019-0553-6

DO - 10.1186/s12894-019-0553-6

M3 - Article

C2 - 31771578

AN - SCOPUS:85075664347

VL - 19

JO - BMC Urology

JF - BMC Urology

SN - 1471-2490

IS - 1

M1 - 121

ER -