You have accessJournal of UrologyProstate Cancer (V14)1 Apr 2020V14-01 A READY TO USE WEB-APPLICATION PROVIDING A PERSONALIZED BIOPSY SCHEDULE FOR MEN WITH LOW-RISK PCA UNDER ACTIVE SURVEILLANCE Anirudh Tomer, Daan Nieboer, Monique Roobol*, Anders Bjartell, Ewout Steyerberg, Dimitris Rizopoulos, and Movember Foundations Global Action Plan Prostate Cancer Active Surveillance (GAP3) consortium Anirudh TomerAnirudh Tomer More articles by this author , Daan NieboerDaan Nieboer More articles by this author , Monique Roobol*Monique Roobol* More articles by this author , Anders BjartellAnders Bjartell More articles by this author , Ewout SteyerbergEwout Steyerberg More articles by this author , Dimitris RizopoulosDimitris Rizopoulos More articles by this author , and Movember Foundations Global Action Plan Prostate Cancer Active Surveillance (GAP3) consortium More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000982.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer patients enrolled in active surveillance (AS) undergo repeat biopsies. Treatment is usually advised when biopsy Gleason grade increases above grade 1 (Gleason 3+3), called upgrading. Periodical nature of biopsies could lead to time delay in detection of upgrading. Therefore, fixed biopsy schedules are commonly used for detecting upgrading timely. Consequently, slow/non-progressing patients undergo many unnecessary biopsies. Our aim is to assist patients/doctors in making better decisions on the timing of biopsies. Using data from the PRIAS AS study, we previously developed a joint model that predicts the risk of upgrading and allows for more personalized biopsy schedules1. METHODS: We validated our model in five of the largest AS cohorts within the Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) database (>20,000 men, 27 centers worldwide). The model includes all PSA and biopsy results, a patients baseline characteristics and schedules can be updated with each subsequent follow-up visit. We estimated the time delay in detection of upgrading for both personalized and fixed schedules, in a patient-specific manner. Issues in validation were resolved by recalibrating our model. Last, we employed our models (recalibrated and original) and personalized schedules in a web-application (http://tiny.cc/biopsy). RESULTS: Rate of upgrading at year 5 of AS in PRIAS and external GAP3 cohorts was maximum 50%. Thus, no biopsies are required in first five years for over half of the patients. PSA velocity was a stronger predictor of upgrading (Adjusted hazard ratio: 2.47, 95%CI: 1.93 - 2.99) than current PSA value (Hazard Ratio: 0.99, 95%CI: 0.89 - 1.11). Moderate Area under ROC curve (0.55 to 0.75) was observed for PRIAS and external GAP3 cohorts. Large mean absolute prediction error (0.3 to 0.45) was seen in cohorts with risk of upgrading different from PRIAS, and moderate (0.1 to 0.3) otherwise. Model required recalibration in all external GAP3 cohorts. CONCLUSIONS: We developed and validated a prediction model that can assist in developing personalized biopsy schedules for patients on AS in the 5 largest cohorts of the movember GAP3 database, at external validation we observed poor calibration showing the need for center-specific adjustments when applying the prediction model in different populations from the PRIAS population. We developed a web-application to enable shared decision making in developing personalized schedules taking into account the expected number of biopsies and time delay in detection of risk upgrading. Source of Funding: Supported by the Movember Foundation. The funder did not play any role in the study design, collection, analysis or interpretation of data, or in the drafting of this paper. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1306-e1306 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anirudh Tomer More articles by this author Daan Nieboer More articles by this author Monique Roobol* More articles by this author Anders Bjartell More articles by this author Ewout Steyerberg More articles by this author Dimitris Rizopoulos More articles by this author Movember Foundations Global Action Plan Prostate Cancer Active Surveillance (GAP3) consortium More articles by this author Expand All Advertisement PDF downloadLoading ...