Precision Medicine in Active Surveillance for Prostate Cancer

Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator

Donna P Ankerst, Jing Xia, Ian M. Thompson, Josef Hoefler, Lisa F. Newcomb, James D. Brooks, Peter R. Carroll, William J. Ellis, Martin E. Gleave, Raymond S. Lance, Peter S. Nelson, Andrew A. Wagner, John T. Wei, Ruth Etzioni, Daniel W. Lin

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Men on active surveillance (AS) face repeated biopsies. Most biopsy specimens will not show disease progression or change management. Such biopsies do not contribute to patient management and are potentially morbid and costly. Objective: To use a contemporary AS prospective trial to develop a tool to predict AS biopsy outcomes. Design, setting, and participants: Biopsy samples (median: 2; range: 2-9 per patient) from 859 men participating in the Canary Prostate Active Surveillance Study and with Gleason 6 prostate cancer (median follow-up: 35.8 mo; range: 3.0-148.7 mo) were analyzed. Outcome measurements and statistical analysis: Logistic regression was used to predict progression, defined as an increase in Gleason score from ≤6 to ≥7 or increase in percentage of cores positive for cancer from <34% to ≥34%. Fivefold internal cross-validation was performed to evaluate the area under the receiver operating characteristic curve (AUC). Results and limitations: Statistically significant risk factors for progression on biopsy were prostate-specific antigen (odds ratio [OR]: 1.045; 95% confidence interval [CI], 1.028-1.063), percentage of cores positive for cancer on most recent biopsy (OR: 1.401; 95% CI, 1.301-1.508), and history of at least one prior negative biopsy (OR: 0.524; 95% CI, 0.417-0.659). A multivariable predictive model incorporating these factors plus age and number of months since last biopsy achieved an AUC of 72.4%. Conclusions: A combination of readily available clinical measures can stratify patients considering AS prostate biopsy. Risk of progression or upgrade can be estimated and incorporated into clinical practice. Patient summary: The Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator, an online tool, can be used to guide patient decision making regarding follow-up prostate biopsy. Urologists can now use the active surveillance biopsy risk calculator to individualize patients' surveillance biopsy schedules. This approach may be attractive to many patients and may increase their participation in joint decision making during follow-up.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - 2015

Fingerprint

Canaries
Precision Medicine
Prostatic Neoplasms
Biopsy
Research
Prostate
Odds Ratio
Confidence Intervals
Area Under Curve
Decision Making
Neoplasm Grading
Age Factors
Prostate-Specific Antigen

Keywords

  • Active surveillance
  • Biopsy
  • Progression
  • Prostate-specific antigen

ASJC Scopus subject areas

  • Urology

Cite this

Precision Medicine in Active Surveillance for Prostate Cancer : Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator. / Ankerst, Donna P; Xia, Jing; Thompson, Ian M.; Hoefler, Josef; Newcomb, Lisa F.; Brooks, James D.; Carroll, Peter R.; Ellis, William J.; Gleave, Martin E.; Lance, Raymond S.; Nelson, Peter S.; Wagner, Andrew A.; Wei, John T.; Etzioni, Ruth; Lin, Daniel W.

In: European Urology, 2015.

Research output: Contribution to journalArticle

Ankerst, DP, Xia, J, Thompson, IM, Hoefler, J, Newcomb, LF, Brooks, JD, Carroll, PR, Ellis, WJ, Gleave, ME, Lance, RS, Nelson, PS, Wagner, AA, Wei, JT, Etzioni, R & Lin, DW 2015, 'Precision Medicine in Active Surveillance for Prostate Cancer: Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator', European Urology. https://doi.org/10.1016/j.eururo.2015.03.023
Ankerst, Donna P ; Xia, Jing ; Thompson, Ian M. ; Hoefler, Josef ; Newcomb, Lisa F. ; Brooks, James D. ; Carroll, Peter R. ; Ellis, William J. ; Gleave, Martin E. ; Lance, Raymond S. ; Nelson, Peter S. ; Wagner, Andrew A. ; Wei, John T. ; Etzioni, Ruth ; Lin, Daniel W. / Precision Medicine in Active Surveillance for Prostate Cancer : Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator. In: European Urology. 2015.
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title = "Precision Medicine in Active Surveillance for Prostate Cancer: Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator",
abstract = "Background: Men on active surveillance (AS) face repeated biopsies. Most biopsy specimens will not show disease progression or change management. Such biopsies do not contribute to patient management and are potentially morbid and costly. Objective: To use a contemporary AS prospective trial to develop a tool to predict AS biopsy outcomes. Design, setting, and participants: Biopsy samples (median: 2; range: 2-9 per patient) from 859 men participating in the Canary Prostate Active Surveillance Study and with Gleason 6 prostate cancer (median follow-up: 35.8 mo; range: 3.0-148.7 mo) were analyzed. Outcome measurements and statistical analysis: Logistic regression was used to predict progression, defined as an increase in Gleason score from ≤6 to ≥7 or increase in percentage of cores positive for cancer from <34{\%} to ≥34{\%}. Fivefold internal cross-validation was performed to evaluate the area under the receiver operating characteristic curve (AUC). Results and limitations: Statistically significant risk factors for progression on biopsy were prostate-specific antigen (odds ratio [OR]: 1.045; 95{\%} confidence interval [CI], 1.028-1.063), percentage of cores positive for cancer on most recent biopsy (OR: 1.401; 95{\%} CI, 1.301-1.508), and history of at least one prior negative biopsy (OR: 0.524; 95{\%} CI, 0.417-0.659). A multivariable predictive model incorporating these factors plus age and number of months since last biopsy achieved an AUC of 72.4{\%}. Conclusions: A combination of readily available clinical measures can stratify patients considering AS prostate biopsy. Risk of progression or upgrade can be estimated and incorporated into clinical practice. Patient summary: The Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator, an online tool, can be used to guide patient decision making regarding follow-up prostate biopsy. Urologists can now use the active surveillance biopsy risk calculator to individualize patients' surveillance biopsy schedules. This approach may be attractive to many patients and may increase their participation in joint decision making during follow-up.",
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T2 - Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator

AU - Ankerst, Donna P

AU - Xia, Jing

AU - Thompson, Ian M.

AU - Hoefler, Josef

AU - Newcomb, Lisa F.

AU - Brooks, James D.

AU - Carroll, Peter R.

AU - Ellis, William J.

AU - Gleave, Martin E.

AU - Lance, Raymond S.

AU - Nelson, Peter S.

AU - Wagner, Andrew A.

AU - Wei, John T.

AU - Etzioni, Ruth

AU - Lin, Daniel W.

PY - 2015

Y1 - 2015

N2 - Background: Men on active surveillance (AS) face repeated biopsies. Most biopsy specimens will not show disease progression or change management. Such biopsies do not contribute to patient management and are potentially morbid and costly. Objective: To use a contemporary AS prospective trial to develop a tool to predict AS biopsy outcomes. Design, setting, and participants: Biopsy samples (median: 2; range: 2-9 per patient) from 859 men participating in the Canary Prostate Active Surveillance Study and with Gleason 6 prostate cancer (median follow-up: 35.8 mo; range: 3.0-148.7 mo) were analyzed. Outcome measurements and statistical analysis: Logistic regression was used to predict progression, defined as an increase in Gleason score from ≤6 to ≥7 or increase in percentage of cores positive for cancer from <34% to ≥34%. Fivefold internal cross-validation was performed to evaluate the area under the receiver operating characteristic curve (AUC). Results and limitations: Statistically significant risk factors for progression on biopsy were prostate-specific antigen (odds ratio [OR]: 1.045; 95% confidence interval [CI], 1.028-1.063), percentage of cores positive for cancer on most recent biopsy (OR: 1.401; 95% CI, 1.301-1.508), and history of at least one prior negative biopsy (OR: 0.524; 95% CI, 0.417-0.659). A multivariable predictive model incorporating these factors plus age and number of months since last biopsy achieved an AUC of 72.4%. Conclusions: A combination of readily available clinical measures can stratify patients considering AS prostate biopsy. Risk of progression or upgrade can be estimated and incorporated into clinical practice. Patient summary: The Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator, an online tool, can be used to guide patient decision making regarding follow-up prostate biopsy. Urologists can now use the active surveillance biopsy risk calculator to individualize patients' surveillance biopsy schedules. This approach may be attractive to many patients and may increase their participation in joint decision making during follow-up.

AB - Background: Men on active surveillance (AS) face repeated biopsies. Most biopsy specimens will not show disease progression or change management. Such biopsies do not contribute to patient management and are potentially morbid and costly. Objective: To use a contemporary AS prospective trial to develop a tool to predict AS biopsy outcomes. Design, setting, and participants: Biopsy samples (median: 2; range: 2-9 per patient) from 859 men participating in the Canary Prostate Active Surveillance Study and with Gleason 6 prostate cancer (median follow-up: 35.8 mo; range: 3.0-148.7 mo) were analyzed. Outcome measurements and statistical analysis: Logistic regression was used to predict progression, defined as an increase in Gleason score from ≤6 to ≥7 or increase in percentage of cores positive for cancer from <34% to ≥34%. Fivefold internal cross-validation was performed to evaluate the area under the receiver operating characteristic curve (AUC). Results and limitations: Statistically significant risk factors for progression on biopsy were prostate-specific antigen (odds ratio [OR]: 1.045; 95% confidence interval [CI], 1.028-1.063), percentage of cores positive for cancer on most recent biopsy (OR: 1.401; 95% CI, 1.301-1.508), and history of at least one prior negative biopsy (OR: 0.524; 95% CI, 0.417-0.659). A multivariable predictive model incorporating these factors plus age and number of months since last biopsy achieved an AUC of 72.4%. Conclusions: A combination of readily available clinical measures can stratify patients considering AS prostate biopsy. Risk of progression or upgrade can be estimated and incorporated into clinical practice. Patient summary: The Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator, an online tool, can be used to guide patient decision making regarding follow-up prostate biopsy. Urologists can now use the active surveillance biopsy risk calculator to individualize patients' surveillance biopsy schedules. This approach may be attractive to many patients and may increase their participation in joint decision making during follow-up.

KW - Active surveillance

KW - Biopsy

KW - Progression

KW - Prostate-specific antigen

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