The next generation of clinical decision making tools: Development of a real-time prediction tool for outcome of prostate biopsy in response to a continuously evolving prostate cancer landscape

Purpose We evaluate whether annual updating of the PCPT Risk Calculator would improve institutional validation compared to static use of the PCPT Risk Calculator alone. Materials and Methods Data from 5 international cohorts including SABOR, Cleveland Clinic, ProtecT, Tyrol and Durham VA, comprising 18,400 biopsies, were used to evaluate an institution specific annual recalibration of the PCPT Risk Calculator. Using all prior years as a training set and the current year as the test set, annual recalibrations of the PCPT Risk Calculator were compared to static use of the PCPT Risk Calculator in terms of AUC and the Hosmer-Lemeshow goodness of fit statistic. Results For predicting high grade disease the median AUC (higher is better) of the recalibrated PCPT Risk Calculator (static PCPT Risk Calculator) across all test years for the 5 cohorts was 67.3 (67.5), 65.0 (60.4), 73.4 (73.4), 73.9 (74.1) and 69.6 (67.2), respectively, and median Hosmer-Lemeshow goodness of fit statistics indicated better fit for recalibration compared to the static PCPT Risk Calculator for Cleveland Clinic, ProtecT and the Durham VA but not for SABOR and Tyrol. For predicting overall cancer median AUC was 63.5 (62.7), 61.0 (57.3), 62.1 (62.5), 66.9 (67.3) and 68.5 (65.5), respectively, and median Hosmer-Lemeshow goodness of fit statistics indicated a better fit for recalibration in all cohorts except for Tyrol. Conclusions A simple method has been provided to tailor the PCPT Risk Calculator to individual hospitals to optimize its accuracy for the patient population at hand.