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    A risk calculator to inform the need for a prostate biopsy: a rapid access clinic cohort

    Jalali, Amirhossein and Foley, Robert W. and Maweni, Robert M. and Murphy, Keefe and Lundon, Dara J. and Lynch, Thomas and Power, Richard and O’Brien, Frank and O’Malley, Kieran J. and Galvin, David J. and Durkan, Garrett C. and Murphy, T. Brendan and Watson, R. William (2020) A risk calculator to inform the need for a prostate biopsy: a rapid access clinic cohort. BMC Medical Informatics and Decision Making, 20 (148). ISSN 1472-6947

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    Background: Prostate cancer (PCa) represents a significant healthcare problem. The critical clinical question is the need for a biopsy. Accurate risk stratification of patients before a biopsy can allow for individualised risk stratification thus improving clinical decision making. This study aims to build a risk calculator to inform the need for a prostate biopsy. Methods: Using the clinical information of 4801 patients an Irish Prostate Cancer Risk Calculator (IPRC) for diagnosis of PCa and high grade (Gleason ≥7) was created using a binary regression model including age, digital rectal examination, family history of PCa, negative prior biopsy and Prostate-specific antigen (PSA) level as risk factors. The discrimination ability of the risk calculator is internally validated using cross validation to reduce overfitting, and its performance compared with PSA and the American risk calculator (PCPT), Prostate Biopsy Collaborative Group (PBCG) and European risk calculator (ERSPC) using various performance outcome summaries. In a subgroup of 2970 patients, prostate volume was included. Separate risk calculators including the prostate volume (IPRCv) for the diagnosis of PCa (and high-grade PCa) was created. Results: IPRC area under the curve (AUC) for the prediction of PCa and high-grade PCa was 0.6741 (95% CI, 0.6591 to 0.6890) and 0.7214 (95% CI, 0.7018 to 0.7409) respectively. This significantly outperforms the predictive ability of cancer detection for PSA (0.5948), PCPT (0.6304), PBCG (0.6528) and ERSPC (0.6502) risk calculators; and also, for detecting high-grade cancer for PSA (0.6623) and PCPT (0.6804) but there was no significant improvement for PBCG (0.7185) and ERSPC (0.7140). The inclusion of prostate volume into the risk calculator significantly improved the AUC for cancer detection (AUC = 0.7298; 95% CI, 0.7119 to 0.7478), but not for high-grade cancer (AUC = 0.7256; 95% CI, 0.7017 to 0.7495). The risk calculator also demonstrated an increased net benefit on decision curve analysis. Conclusion: The risk calculator developed has advantages over prior risk stratification of prostate cancer patients before the biopsy. It will reduce the number of men requiring a biopsy and their exposure to its side effects. The interactive tools developed are beneficial to translate the risk calculator into practice and allows for clarity in the clinical recommendations.

    Item Type: Article
    Additional Information: Cite as: Jalali, A., Foley, R.W., Maweni, R.M. et al. A risk calculator to inform the need for a prostate biopsy: a rapid access clinic cohort. BMC Med Inform Decis Mak 20, 148 (2020). © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
    Keywords: Biopsy; Prostate Cancer; Decision-making; Risk calculator; Binary logistic regression, cross-validation, Rshiny;
    Academic Unit: Faculty of Science and Engineering > Mathematics and Statistics
    Item ID: 15554
    Identification Number:
    Depositing User: Keefe Murphy
    Date Deposited: 22 Feb 2022 16:46
    Journal or Publication Title: BMC Medical Informatics and Decision Making
    Publisher: BMC
    Refereed: Yes
    Use Licence: This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here

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