Improving patient prostate cancer risk assessment: Moving from static, globally-applied to dynamic, practice-specific risk calculators

J Biomed Inform. 2015 Aug;56:87-93. doi: 10.1016/j.jbi.2015.05.001. Epub 2015 May 16.

Abstract

Clinical risk calculators are now widely available but have generally been implemented in a static and one-size-fits-all fashion. The objective of this study was to challenge these notions and show via a case study concerning risk-based screening for prostate cancer how calculators can be dynamically and locally tailored to improve on-site patient accuracy. Yearly data from five international prostate biopsy cohorts (3 in the US, 1 in Austria, 1 in England) were used to compare 6 methods for annual risk prediction: static use of the online US-developed Prostate Cancer Prevention Trial Risk Calculator (PCPTRC); recalibration of the PCPTRC; revision of the PCPTRC; building a new model each year using logistic regression, Bayesian prior-to-posterior updating, or random forests. All methods performed similarly with respect to discrimination, except for random forests, which were worse. All methods except for random forests greatly improved calibration over the static PCPTRC in all cohorts except for Austria, where the PCPTRC had the best calibration followed closely by recalibration. The case study shows that a simple annual recalibration of a general online risk tool for prostate cancer can improve its accuracy with respect to the local patient practice at hand.

Keywords: Calibration; Discrimination; Logistic regression; Prediction; Prostate cancer; Revision.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Austria
  • Bayes Theorem
  • Biopsy
  • Calibration
  • Cohort Studies
  • Databases, Factual
  • England
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / epidemiology
  • Reproducibility of Results
  • Risk Assessment / methods*
  • United States

Substances

  • Prostate-Specific Antigen