Comparative analysis of biopsy upgrading in four prostate cancer active surveillance cohorts

Lurdes Y.T. Inoue, Daniel W. Lin, Lisa F. Newcomb, Amy S. Leonardson, Donna P Ankerst, Roman Gulati, H. Ballentine Carter, Bruce J. Trock, Peter R. Carroll, Matthew R. Cooperberg, Janet E. Cowan, Laurence H. Klotz, Alexandre Mamedov, David F. Penson, Ruth Etzioni

Research output: Contribution to journalArticle

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Abstract

Background: Active surveillance (AS) is increasingly accepted for managing low-risk prostate cancer, yet there is no consensus about implementation. This lack of consensus is due in part to uncertainty about risks for disease progression, which have not been systematically compared or integrated across AS studies with variable surveillance protocols and dropout to active treatment. Objective: To compare risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across AS studies after accounting for differences in surveillance intervals and competing treatments and to evaluate tradeoffs of more versus less frequent biopsies. Design: Joint statistical model of longitudinal prostate-specific antigen (PSA) levels and risks for biopsy upgrading. Setting: Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF); and University of Toronto (UT) AS studies. Patients: 2576 men aged 40 to 80 years with a GS between 2 and 6 and clinical stage T1 or T2 prostate cancer enrolled between 1995 and 2014.

Measurements: PSA levels and biopsy GSs. Results: After variable surveillance intervals and competing treatments were accounted for, estimated risks for biopsy upgrading were similar in the PASS and UT studies but higher in UCSF and lower in JHU studies. All cohorts had a delay of 3 to 5 months in detecting upgrading with biennial biopsies starting after a first confirmatory biopsy versus annual biopsies. Limitation: The model does not account for possible misclassification of biopsy GS. Conclusion: Men in different AS studies have different risks for biopsy upgrading after variable surveillance protocols and competing treatments are accounted for. Despite these differences, the consequences of more versus less frequent biopsies seem to be similar across cohorts. Biennial biopsies seem to be an acceptable alternative to annual biopsies. Primary Funding Source: National Cancer Institute.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Internal Medicine
Volume168
Issue number1
DOIs
StatePublished - Jan 2 2018
Externally publishedYes

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Prostatic Neoplasms
Biopsy
Neoplasm Grading
San Francisco
Prostate-Specific Antigen
Prostate
Canaries
National Cancer Institute (U.S.)
Statistical Models
Clinical Protocols
Uncertainty
Disease Progression
Therapeutics
Joints

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Inoue, L. Y. T., Lin, D. W., Newcomb, L. F., Leonardson, A. S., Ankerst, D. P., Gulati, R., ... Etzioni, R. (2018). Comparative analysis of biopsy upgrading in four prostate cancer active surveillance cohorts. Annals of Internal Medicine, 168(1), 1-9. https://doi.org/10.7326/M17-0548

Comparative analysis of biopsy upgrading in four prostate cancer active surveillance cohorts. / Inoue, Lurdes Y.T.; Lin, Daniel W.; Newcomb, Lisa F.; Leonardson, Amy S.; Ankerst, Donna P; Gulati, Roman; Carter, H. Ballentine; Trock, Bruce J.; Carroll, Peter R.; Cooperberg, Matthew R.; Cowan, Janet E.; Klotz, Laurence H.; Mamedov, Alexandre; Penson, David F.; Etzioni, Ruth.

In: Annals of Internal Medicine, Vol. 168, No. 1, 02.01.2018, p. 1-9.

Research output: Contribution to journalArticle

Inoue, LYT, Lin, DW, Newcomb, LF, Leonardson, AS, Ankerst, DP, Gulati, R, Carter, HB, Trock, BJ, Carroll, PR, Cooperberg, MR, Cowan, JE, Klotz, LH, Mamedov, A, Penson, DF & Etzioni, R 2018, 'Comparative analysis of biopsy upgrading in four prostate cancer active surveillance cohorts', Annals of Internal Medicine, vol. 168, no. 1, pp. 1-9. https://doi.org/10.7326/M17-0548
Inoue LYT, Lin DW, Newcomb LF, Leonardson AS, Ankerst DP, Gulati R et al. Comparative analysis of biopsy upgrading in four prostate cancer active surveillance cohorts. Annals of Internal Medicine. 2018 Jan 2;168(1):1-9. https://doi.org/10.7326/M17-0548
Inoue, Lurdes Y.T. ; Lin, Daniel W. ; Newcomb, Lisa F. ; Leonardson, Amy S. ; Ankerst, Donna P ; Gulati, Roman ; Carter, H. Ballentine ; Trock, Bruce J. ; Carroll, Peter R. ; Cooperberg, Matthew R. ; Cowan, Janet E. ; Klotz, Laurence H. ; Mamedov, Alexandre ; Penson, David F. ; Etzioni, Ruth. / Comparative analysis of biopsy upgrading in four prostate cancer active surveillance cohorts. In: Annals of Internal Medicine. 2018 ; Vol. 168, No. 1. pp. 1-9.
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abstract = "Background: Active surveillance (AS) is increasingly accepted for managing low-risk prostate cancer, yet there is no consensus about implementation. This lack of consensus is due in part to uncertainty about risks for disease progression, which have not been systematically compared or integrated across AS studies with variable surveillance protocols and dropout to active treatment. Objective: To compare risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across AS studies after accounting for differences in surveillance intervals and competing treatments and to evaluate tradeoffs of more versus less frequent biopsies. Design: Joint statistical model of longitudinal prostate-specific antigen (PSA) levels and risks for biopsy upgrading. Setting: Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF); and University of Toronto (UT) AS studies. Patients: 2576 men aged 40 to 80 years with a GS between 2 and 6 and clinical stage T1 or T2 prostate cancer enrolled between 1995 and 2014.Measurements: PSA levels and biopsy GSs. Results: After variable surveillance intervals and competing treatments were accounted for, estimated risks for biopsy upgrading were similar in the PASS and UT studies but higher in UCSF and lower in JHU studies. All cohorts had a delay of 3 to 5 months in detecting upgrading with biennial biopsies starting after a first confirmatory biopsy versus annual biopsies. Limitation: The model does not account for possible misclassification of biopsy GS. Conclusion: Men in different AS studies have different risks for biopsy upgrading after variable surveillance protocols and competing treatments are accounted for. Despite these differences, the consequences of more versus less frequent biopsies seem to be similar across cohorts. Biennial biopsies seem to be an acceptable alternative to annual biopsies. Primary Funding Source: National Cancer Institute.",
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AU - Newcomb, Lisa F.

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AU - Ankerst, Donna P

AU - Gulati, Roman

AU - Carter, H. Ballentine

AU - Trock, Bruce J.

AU - Carroll, Peter R.

AU - Cooperberg, Matthew R.

AU - Cowan, Janet E.

AU - Klotz, Laurence H.

AU - Mamedov, Alexandre

AU - Penson, David F.

AU - Etzioni, Ruth

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N2 - Background: Active surveillance (AS) is increasingly accepted for managing low-risk prostate cancer, yet there is no consensus about implementation. This lack of consensus is due in part to uncertainty about risks for disease progression, which have not been systematically compared or integrated across AS studies with variable surveillance protocols and dropout to active treatment. Objective: To compare risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across AS studies after accounting for differences in surveillance intervals and competing treatments and to evaluate tradeoffs of more versus less frequent biopsies. Design: Joint statistical model of longitudinal prostate-specific antigen (PSA) levels and risks for biopsy upgrading. Setting: Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF); and University of Toronto (UT) AS studies. Patients: 2576 men aged 40 to 80 years with a GS between 2 and 6 and clinical stage T1 or T2 prostate cancer enrolled between 1995 and 2014.Measurements: PSA levels and biopsy GSs. Results: After variable surveillance intervals and competing treatments were accounted for, estimated risks for biopsy upgrading were similar in the PASS and UT studies but higher in UCSF and lower in JHU studies. All cohorts had a delay of 3 to 5 months in detecting upgrading with biennial biopsies starting after a first confirmatory biopsy versus annual biopsies. Limitation: The model does not account for possible misclassification of biopsy GS. Conclusion: Men in different AS studies have different risks for biopsy upgrading after variable surveillance protocols and competing treatments are accounted for. Despite these differences, the consequences of more versus less frequent biopsies seem to be similar across cohorts. Biennial biopsies seem to be an acceptable alternative to annual biopsies. Primary Funding Source: National Cancer Institute.

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