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JU INSIGHT Development and Validation of a Prostate Biopsy Risk Calculator in Black Men
By: Neil A. Mistry, MD, MPH, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Zequn Sun, PhD, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Jamila Sweis, BS, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Cordero McCall, MBA, MPH, Medical College of Wisconsin, Milwaukee; Norma Marshall, BS, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Bernice Ofori, MPH, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Courtney M. P. Hollowell, MD, Cook County Health, Chicago, Illinois; Rick A. Kittles, PhD, Morehouse School of Medicine, Atlanta, Georgia; Edward M. Schaeffer, MD, PhD, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Michael Abern, MD, University of Illinois at Chicago; Peter Gann, MD, ScD, University of Illinois at Chicago; Adam B. Murphy, MD, MBA, MSCI, Northwestern University Feinberg School of Medicine, Chicago, Illinois | Posted on: 21 Feb 2024
Mistry NA, Sun Z, Sweis J, et al. Development and validation of a prostate biopsy risk calculator in Black men. J Urol. 2024;211(2):223-233.
Study Need and Importance
Black men face higher incidence and mortality than non-Black men with respect to prostate cancer (PCa). Multivariable risk calculators (RCs) were developed to stratify patients undergoing prostate biopsy to reduce unnecessary biopsies and improve detection of clinically significant prostate cancer (csPCa). These calculators have historically relied on homogenous cohorts with few ethnic minorities, with concern for poorer calibration in low-risk Black men.
What We Found
We developed and validated 3 RCs tailored specifically to Black men using 2 cohorts of patients undergoing prostate biopsies in Chicago, Illinois. Using 2 modeling approaches, we created Mistry-Sun (MS) RCs 1 to 3 that use clinical variables likely available in (1) primary care office settings, (2) initial urologist consultation, and (3) subsequent urologist evaluation. We found that our models had an improved or similar area under the curve when compared against several available RCs. Our models showed better calibration for low-risk men resulting in fewer unnecessary biopsies (a combination of benign or Gleason Grade Group 1) than other available calculators with similar and appropriate risks of missed csPCa. The Table demonstrates how MS and other calculators perform in our external validation cohort with respect to missed csPCa and unnecessary biopsies. At lower risk thresholds, MS3 outperforms all other calculators since prostate volume addresses PSA elevation from benign prostatic hyperplasia. MS models 1, 2, and 3 reduce unnecessary biopsies at the 30% risk threshold compared to other RCs with a commensurate proportion of missed csPCa.
Table. Comparison of Biopsy Outcomes at 10% and 30% Risk Thresholds in the External Validation Cohort (N = 276)
| Mistry-Sun 1 | Mistry-Sun 2 | Mistry-Sun 3 | PCPT | PBCG | Kaiser | |
|---|---|---|---|---|---|---|
| 10% biopsy threshold | ||||||
| Men below 10% threshold, No. | 6 | 1 | 30 | 15 | 12 | 0 |
| Total biopsies performed, No. | 270 | 275 | 246 | 261 | 264 | 276 |
| Missed GG2-5 among men below the 10% threshold, No. (%) | 0 (0) | 0 (0) | 0 (0) | 3 (20.0) | 3 (25) | 0 (0) |
| Unnecessary biopsies, No. | 169 | 174 | 145 | 163 | 166 | 175 |
| 30% biopsy threshold | ||||||
| Men below 30% threshold, No. | 202 | 219 | 183 | 172 | 137 | 17 |
| Total biopsies performed, No. | 74 | 57 | 93 | 104 | 139 | 259 |
| Missed GG2-5 among men below the 30% threshold, No. (%) | 55 (27.2) | 60 (27.4) | 42 (23.0) | 46 (26.7) | 31 (22.6) | 4 (23.5) |
| Unnecessary biopsies, No. | 28 | 16 | 34 | 49 | 69 | 162 |
| Abbreviations: GG, Gleason Grade Group; Kaiser, Kaiser Permanente Prostate Cancer risk calculator; PBCG, Prostate Biopsy Collaborative Group risk calculator; PCPT, Prostate Cancer Prevention Trial risk calculator version 2.0. For men willing to undergo prostate biopsy if there is 10% or 30% risk of GG2 to GG5 prostate cancer, we list the number of men who fall below the threshold (tests negative), the total number of biopsies performed (tests positive), the number of missed GG2 to GG5 cancers (false-negatives, which should be ≤10% or ≤30% from the patient’s perspective), and the number of unnecessary biopsies performed for men with GG1 prostate cancer or a negative biopsy. There were complete data in 276 out of the 292 men. |
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Limitations
Our study recruited a relatively small sample size and only within Chicago. We also did not incorporate more modern components of the PCa workup including MRI and biomarkers.
Interpretation for Patient Care
This is the first study to develop and validate a PCa risk-stratification tool specifically for Black men. Our tailored RCs can reduce unnecessary biopsies for Black men and addresses access disparities in precision oncology tools.
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