Clinical risk calculator validation and implementation to optimize prostate cancer early detection in Nigeria

About This Grant

PROJECT SUMMARY/ABSTRACT The burden of prostate cancer diagnosis and its mortality in Nigeria is high. Delay in patient presentation to urologists at tertiary healthcare facilities is a major challenge, resulting in diagnosis with advanced disease and suboptimal quality of life of patients. Despite this challenge, optimal screening is hampered by the low specificity of prostate specific antigen for the detection of clinically significant prostate cancer leading to unnecessary biopsies and overdiagnosis. To combat this problem, prostate cancer clinical risk calculators have been deployed to identify men at high risk of clinically significant disease. These risk calculators have variable predictive values across different populations. The Rotterdam Risk Calculator and Prostate Biopsy Collaborative Group Risk Calculator have been extensively validated in the European ancestry population. The Mistry-Sun Risk Calculator is however better calibrated for U.S. Black men. None of these tools has been validated for the Nigerian population. Moreover, very few prostate cancer risk calculators can be readily used at community-level hospitals. As human and material resource availability for prostate cancer risk assessment varies between urologists and primary care providers and between Nigeria and other countries, foundational research should focus on developing and implementing contextually appropriate models “Naija risk calculators” that will be easy to integrate into Nigerian clinical practice. To address this gap, this mentored research proposal aims to: (1) compare the accuracy of existing risk calculators for predicting clinically significant prostate cancer in a prospective cohort of Nigerian men; (2) develop tailored multinomial regression models for the prediction of clinically significant prostate cancer in Nigeria; and (3) conduct a pilot implementation trial of a risk calculator to optimize community-based Prostate Cancer Early Detection Intervention in Nigeria. To achieve these aims, Dr. Tolani will leverage existing research partnerships in Nigeria, and a unique multidisciplinary team of mentors with necessary research expertise for the Nigerian prostate cancer context, prediction modeling, implementation science and global oncology. The proposed research will result in validated risk calculators that can be feasible to implement in a future R01 hybrid trial of a primary care provider-facing risk calculator in a refined Prostate Cancer Early Detection Intervention. This K43 award will also support advanced training in: (1) statistical methods for diagnostic tool evaluation; (2) clinical prediction modeling; (3) implementation science study designs; and (4) global oncology leadership. For each goal, Dr. Tolani will complete courses, mentored tutorials, and experiential learning from the research aims. This training will position Dr. Tolani for a successful independent career in precision-informed early and optimal prostate cancer detection and global oncology, advancing his ultimate goal of addressing cancer disparities through team science and collaborations in Nigeria and beyond.