{
  "abstract": "Background: Multiparametric MRI (mpMRI)-integrated risk calculators may improve individualized prediction of clinically significant prostate cancer (csPCa) before biopsy. We externally validated and directly compared the MRI-based Radtke and Alberts risk calculators (Radtke-RC and Alberts-RC) in a contemporary MRI-selected biopsy cohort, assessing discrimination, calibration, and clinical utility. Methods: Consecutive patients undergoing pre-biopsy mpMRI followed by combined MRI-targeted and systematic biopsy were retrospectively identified. The primary endpoint was csPCa, defined as ISUP Grade Group ≥ 2. Discrimination was assessed using receiver operating characteristic analysis, calibration using observed-to-expected (O:E) ratios, calibration-in-the-large (slope fixed at 1), calibration slopes, and calibration plots, and clinical utility using decision curve analysis. Radtke-RC validation was restricted to biopsy-naïve patients, while head-to-head comparisons were restricted to biopsy-naïve patients evaluable for both calculators. Threshold probabilities of 12%, 20%, and 30% were examined, with bootstrap confidence intervals for incremental net benefit. Results: Of 171 screened patients, seven had no evaluable biopsy outcome. The Radtke-RC validation cohort comprised 144 biopsy-naïve patients, including 55 (38.2%) with csPCa. The Alberts-RC was evaluable in 114 patients; 50 patients could not be assessed because age, prostate volume, or PSA values were outside the online calculator’s permitted input ranges. The common biopsy-naïve cohort comprised 97 patients, including 34 (35.1%) with csPCa. In the model-specific cohorts, AUCs were 0.765 (95% CI 0.682–0.848) for the Radtke-RC and 0.767 (95% CI 0.672–0.861) for the Alberts-RC. In the common cohort, AUCs were 0.774 (95% CI 0.672–0.875) and 0.768 (95% CI 0.661–0.874), respectively, with no statistically significant paired difference (0.006, 95% CI −0.028 to 0.040; p = 0.726). Calibration differed substantially: the Radtke-RC overpredicted risk (mean predicted risk 48.2%; O:E 0.727), whereas the Alberts-RC underpredicted risk (18.0%; O:E 1.944). At thresholds of 12%, 20%, and 30%, the Radtke-RC classified zero, seven, and 25 patients below threshold and missed zero, zero, and four csPCa cases, respectively; corresponding values for the Alberts-RC were 42, 64, and 78 patients below threshold, with seven, 12, and 20 csPCa cases missed. Sensitivity analyses indicated less favourable Radtke-RC decision-analytic performance outside the common cohort, whereas restriction to PI-RADS 4–5 patients did not materially alter relative discrimination. Conclusions: No statistically significant difference in discrimination between the Radtke-RC and Alberts-RC was detected, although the study was not powered to establish equivalence. Despite similar discrimination, the calculators showed substantially different calibration and threshold-specific clinical consequences. In this MRI-selected population, interpretation of fixed risk thresholds should therefore account for calibration, patient selection, and the trade-off between biopsy avoidance and missed csPCa.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Urology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hubert Grießner",
      "orcid": "0000-0002-5499-2653"
    },
    {
      "affs": [
        0
      ],
      "name": "Sarah K. Luck"
    },
    {
      "affs": [
        0
      ],
      "name": "Julia K. Peters",
      "orcid": "0009-0005-2286-1631"
    },
    {
      "affs": [
        0
      ],
      "name": "Kathrin Olesch"
    },
    {
      "affs": [
        0
      ],
      "name": "Manuel Schlachter"
    },
    {
      "affs": [
        0
      ],
      "name": "Lukas Oberhammer",
      "orcid": "0000-0002-9147-2032"
    },
    {
      "affs": [
        0
      ],
      "name": "Maximilian Pallauf"
    },
    {
      "affs": [
        0
      ],
      "name": "Lukas Lusuardi",
      "orcid": "0000-0002-5284-7276"
    },
    {
      "affs": [
        0
      ],
      "name": "Philipp N. Haid",
      "orcid": "0009-0003-7909-4862"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6pd0k4acmh261.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15208146",
  "fulltext_url": null,
  "id": "6pd0k4acmh261",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/8146",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Prostate Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7213338336",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-20",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/6pd0k4acmh261.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:01Z",
      "native_id": "10.3390/jcm15208146",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/8146"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Prostate Cancer Diagnosis and Treatment",
      "subfield": "general"
    }
  ],
  "title": "External Validation of MRI-Based Prostate Cancer Risk Calculators in a Contemporary Pre-Biopsy mpMRI Cohort",
  "title_text": "External Validation of MRI-Based Prostate Cancer Risk Calculators in a Contemporary Pre-Biopsy mpMRI Cohort",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:01Z",
  "url": "https://research.draconitic.com/paper/6pd0k4acmh261",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}