Validating the European randomised study for screening of prostate cancer (ERSPC) risk calculator in a contemporary South African cohort

  • Bhavish Kowlessur
  • Manraj Phull
  • Bhavin Patel
  • Michelle Henry
  • John LazarusEmail author
Original Article



Numerous prostate cancer predictive tools have been developed to help with decision-making in men needing prostate biopsy. However, they have been modelled and validated almost exclusively in Caucasian cohorts, hence limiting their use in other population groups. The aim of this study was to assess the validity of the ERSPC risk calculator in a South African cohort.


Patients who have had a transrectal ultrasound (TRUS)-guided prostate biopsy at Groote Schuur Hospital from January 2008 to August 2017 were reviewed. Predictor variables were entered into the ERSPC risk calculator and results were compared with prostate biopsy pathology results. Predictive accuracy of the ERSPC risk calculator for these patients was derived using receiver operator characteristics (ROC) Area under the curve and is expressed as a percentage.


516 prostate biopsy sessions in 475 different men were analysed. The predictive accuracy of the ERSPC risk calculator was better than a PSA/DRE strategy for the presence of cancer—0.738 (95% CI 0.695–0.781) vs 0.686 (95% CI 0.639–0.732), and for significant PCa—0.833 (95% CI 0.789–0.876) vs 0.793 (95% CI 0.741–0.846). This translated into 50 less biopsies when compared to a PSA > 4/abnormal DRE strategy. Use of the ERSPC RC would have missed eight non-significant cancers [Significant cancer being defined as having a tumour stage T2b (> 1/2 lobe involved with prostate cancer) and/or a Gleason Score equal to or greater than 7].


Our results confirm the validity of the ERSPC RC in a South African cohort. Application of this calculator to the wider South African population would allow better selection of patients for prostate biopsy and spare a significant number its adverse consequences.


Prostate cancer Risk calculator Prognosis 


Author contributions

BK protocol/project development, data collection or management, data analysis, manuscript writing/editing. MP data collection or management. BP data collection or management. MH data analysis. JL manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest.

Ethical approval

The research involved Human Participants. The study was approved by the Human Research Ethics Committee of the University of Cape Town. Reference Number: 324/2018.

Informed consent

No specific informed consent was obtained from the patients.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Bhavish Kowlessur
    • 1
  • Manraj Phull
    • 3
  • Bhavin Patel
    • 1
  • Michelle Henry
    • 2
  • John Lazarus
    • 1
    Email author
  1. 1.Division of UrologyGroote Schuur Hospital, University of Cape TownCape TownSouth Africa
  2. 2.The Numeracy CentreUniversity of Cape TownCape TownSouth Africa
  3. 3.St Georges University HospitalLondonUK

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