Abstract
PurposeTo study whether probabilistic selection by the use of a nomogram could improve patient selection for active surveillance (AS) compared to the various sets of rule-based AS inclusion criteria currently used.MethodsWe studied Dutch and Swedish patients participating in the European Randomized study of Screening for Prostate Cancer (ERSPC). We explored which men who were initially diagnosed with cT1-2, Gleason 6 (Gleason pattern ≤3 + 3) had histopathological indolent PCa at RP [defined as pT2, Gleason pattern ≤3 and tumour volume (TV) ≤0.5 or TV ≤ 1.3 ml, and TV no part of criteria (NoTV)]. Rule-based selection was according to the Prostate cancer Research International: Active Surveillance (PRIAS), Klotz, and Johns Hopkins criteria. An existing nomogram to define probability-based selection for AS was refitted for the TV1.3 and NoTV indolent PCa definitions.Results619 of 864 men undergoing RP had cT1-2, Gleason 6 disease at diagnosis and were analysed. Median follow-up was 8.9 years. 229 (37 %), 356 (58 %), and 410 (66 %) fulfilled the TV0.5, TV1.3, and NoTV indolent PCa criteria at RP. Discriminating between indolent and significant disease according to area under the curve (AUC) was: TV0.5: 0.658 (PRIAS), 0.523 (Klotz), 0.642 (Hopkins), 0.685 (nomogram). TV1.3: 0.630 (PRIAS), 0.550 (Klotz), 0.615 (Hopkins), 0.646 (nomogram). NoTV: 0.603 (PRIAS), 0.530 (Klotz), 0.589 (Hopkins), 0.608 (nomogram).ConclusionsThe performance of a nomogram, the Johns Hopkins, and PRIAS rule-based criteria are comparable. Because the nomogram allows individual trade-offs, it could be a good alternative to rigid rule-based criteria.Electronic supplementary materialThe online version of this article (doi:10.1007/s00345-015-1628-y) contains supplementary material, which is available to authorized users.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Department of Urology, Erasmus University Medical Center, Room Na1710, P.O
In our cohort of Dutch and Swedish screen-detected prostate cancer (PCa) patients who all underwent initial radical prostatectomy (RP), 37 % fulfilled the TV0.5 indolent PCa criteria at RP increasing to 58 % for the TV1.3 indolent PCa criteria and 66 % for the NoTV indolent PCa definition
More stringent rule-based Active surveillance (AS) inclusion criteria as well as stricter nomogram probability thresholds decrease the rate of misclassified tumours in a rather similar fashion, but both at the cost of a substantial number of patients no longer considered suitable for AS
Summary
Electronic supplementary material The online version of this article (doi:10.1007/s00345-015-1628-y) contains supplementary material, which is available to authorized users. Detection of prostate cancer (PCa) has led to increased prevalence of finding indolent tumours, i.e. tumours that are unlikely to become symptomatic during life. The ability to predict indolent PCa is needed to avoid overtreatment [1]. Active surveillance (AS) has emerged as a feasible strategy to decrease the overtreatment of low-risk PCa. With AS, men with low-risk PCa are strictly monitored over time, and if risk reclassification or disease progression occurs, they can opt for curative therapy. The aim of AS is to safely delay or completely avoid side effects of active therapy [2]. There are 16 unique worldwide AS cohorts which all have their highly variable own protocols [3]. Published results on AS study cohorts worldwide show encouraging results on biochemical
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