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@ARTICLE{Radtke:144615,
      author       = {J. P. Radtke$^*$ and F. Giganti and M. Wiesenfarth$^*$ and
                      A. Stabile and J. Marenco and C. Orczyk and V.
                      Kasivisvanathan and J. N. Nyarangi-Dix and V. Schütz and S.
                      Dieffenbacher$^*$ and M. Görtz and A. Stenzinger and W.
                      Roth and A. Freeman and S. Punwani and D. Bonekamp$^*$ and
                      H.-P. Schlemmer$^*$ and M. Hohenfellner and M. Emberton and
                      C. M. Moore},
      title        = {{P}rediction of significant prostate cancer in
                      biopsy-naïve men: {V}alidation of a novel risk model
                      combining {MRI} and clinical parameters and comparison to an
                      {ERSPC} risk calculator and {PI}-{RADS}.},
      journal      = {PLOS ONE},
      volume       = {14},
      number       = {8},
      issn         = {1932-6203},
      address      = {San Francisco, California, US},
      publisher    = {PLOS},
      reportid     = {DKFZ-2019-02057},
      pages        = {e0221350 -},
      year         = {2019},
      abstract     = {Risk models (RM) need external validation to assess their
                      value beyond the setting in which they were developed. We
                      validated a RM combining mpMRI and clinical parameters for
                      the probability of harboring significant prostate cancer
                      (sPC, Gleason Score ≥ 3+4) for biopsy-naïve men.The
                      original RM was based on data of 670 biopsy-naïve men from
                      Heidelberg University Hospital who underwent mpMRI with
                      PI-RADS scoring prior to MRI/TRUS-fusion biopsy 2012-2015.
                      Validity was tested by a consecutive cohort of biopsy-naïve
                      men from Heidelberg (n = 160) and externally by a cohort of
                      133 men from University College London Hospital (UCLH).
                      Assessment of validity was performed at fusion-biopsy by
                      calibration plots, receiver operating characteristics curve
                      and decision curve analyses. The RM`s performance was
                      compared to ERSPC-RC3, ERSPC-RC3+PI-RADSv1.0 and PI-RADSv1.0
                      alone.SPC was detected in 76 men $(48\%)$ at Heidelberg and
                      38 men $(29\%)$ at UCLH. The areas under the curve (AUC)
                      were 0.86 for the RM in both cohorts. For
                      ERSPC-RC3+PI-RADSv1.0 the AUC was 0.84 in Heidelberg and
                      0.82 at UCLH, for ERSPC-RC3 0.76 at Heidelberg and 0.77 at
                      UCLH and for PI-RADSv1.0 0.79 in Heidelberg and 0.82 at
                      UCLH. Calibration curves suggest that prevalence of sPC
                      needs to be adjusted to local circumstances, as the RM
                      overestimated the risk of harboring sPC in the UCLH cohort.
                      After prevalence-adjustment with respect to the prevalence
                      underlying ERSPC-RC3 to ensure a generalizable comparison,
                      not only between the Heidelberg and die UCLH subgroup, the
                      RM`s Net benefit was superior over the ERSPC`s and the
                      mpMRI`s for threshold probabilities above 0.1 in both
                      cohorts.The RM discriminated well between men with and
                      without sPC at initial MRI-targeted biopsy but overestimated
                      the sPC-risk at UCLH. Taking prevalence into account, the
                      model demonstrated benefit compared with clinical risk
                      calculators and PI-RADSv1.0 in making the decision to biopsy
                      men at suspicion of PC. However, prevalence differences must
                      be taken into account when using or validating the presented
                      risk model.},
      cin          = {E010 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:31450235},
      doi          = {10.1371/journal.pone.0221350},
      url          = {https://inrepo02.dkfz.de/record/144615},
}