673 A NOMOGRAM PREDICTING THE RISK OF PROGRESSION IN PATIENTS MANAGED BY ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized (III)1 Apr 2013673 A NOMOGRAM PREDICTING THE RISK OF PROGRESSION IN PATIENTS MANAGED BY ACTIVE SURVEILLANCE Viacheslav Iremashvili, Joshua Burdick-Will, Amanda Mure, and Mark S. Soloway Viacheslav IremashviliViacheslav Iremashvili Miami, FL More articles by this author , Joshua Burdick-WillJoshua Burdick-Will Miami, FL More articles by this author , Amanda MureAmanda Mure Miami, FL More articles by this author , and Mark S. SolowayMark S. Soloway Miami, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.228AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although a number of risk factors of biopsy progression in active surveillance patients are known, we are not able to quantify individual risk. We developed a clinical tool that integrates different risk factors and provides individual predictions of the risk of biopsy progression. METHODS Our analysis included 194 active surveillance patients, each of whom had had at least two surveillance biopsies. We used the Cox proportional hazard regression model to analyze the association between different risk factors and the progression-free survival. This multivariate model was then used to develop a nomogram. Discrimination and calibration of the nomogram were internally validated using 200 bootstrap resamplings. RESULTS The median follow-up of patients free of progression was 4.3 years. 51 (26%) patients progressed. Factors statistically significantly associated with progression were: overall number of positive cores in the diagnostic and first surveillance biopsies, race and prostate-specific antigen density (Figure 1). The bootstrapping concordance index of the nomogram including these parameters was 78.7%. The nomogram tended to underestimate the probability of progression however it fairly accurately identified distinct groups of patients with low, intermediate and high risk (Figure 2). CONCLUSIONS In the development cohort, the nomogram was able to separate patients with respect to their risk of biopsy progression. Since accurate risk stratification is essential to optimize patient care, this tool, if external validation confirms its performance, may prove useful for both the counseling and management of patients with low-volume, Gleason 6 prostate cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e275-e276 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Viacheslav Iremashvili Miami, FL More articles by this author Joshua Burdick-Will Miami, FL More articles by this author Amanda Mure Miami, FL More articles by this author Mark S. Soloway Miami, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...