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    Prostate Ca: Novel model predicts ‘true cancer state’

    Proposed tool may help guide decisions for men undergoing active surveillance

    San Diego—Although various calculators are available for predicting biopsy results in men with prostate cancer being managed by active surveillance, a novel model developed by researchers at Johns Hopkins University is unique for its ability to predict a patient’s “true cancer state”; ie, the Gleason score that would be assigned on whole-gland analysis after radical prostatectomy. 

    Read: AUA '16 PCa take-homes: PSA drop, active surveillance are key themes

    Initial evaluation of the model’s performance in a cohort of 191 men in active surveillance who opted to undergo radical prostatectomy demonstrated that it had good accuracy in predicting the probability of having a true Gleason score ≥7. Mean absolute error was almost 0, reported first author Yates Coley, PhD, at the AUA annual meeting in San Diego. A paper discussing the model was more recently published in European Urology (Aug. 11, 2016 A [Epub ahead of print]).

    “Active surveillance has been shown to be a safe alternative to curative intervention for men with favorable-risk prostate cancer. Yet overtreatment of localized disease persists, and uncertainty surrounding biopsy Gleason scores is a key factor driving that problem,” said Dr. Coley, postdoctoral fellow in biostatistics at Johns Hopkins School of Public Health, Baltimore.

    “Our model aims to address the latter issue by predicting the true Gleason score,” added Dr. Coley, who worked on the study with H. Ballentine Carter, MD, and colleagues.

    The Bayesian joint model was fit with data from men in the Johns Hopkins Active Surveillance Cohort. It incorporates patient age and uses all PSA and biopsy Gleason score data obtained at diagnosis and during active surveillance.

    “Our methodology reflects the fact that we will have more confidence that an individual is actually harboring indolent disease when he has multiple biopsy Gleason scores of 6 versus a single score from the diagnostic biopsy,” Dr. Coley said.

    The model also assumes that PSA values will gradually rise with age, correlate in an individual over time, and suggest the presence of more aggressive prostate cancer if the level is higher or rising quickly.

    Next: Tool will be integrated with EHR

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