Abstract
Purpose: We assessed whether Prostate Health Index results improve prediction of grade reclassification for men on active surveillance. Methods and Materials: We identified men in Canary Prostate Active Surveillance Study with Grade Group 1 cancer. Outcome was grade reclassification to Grade Group 2D cancer. We considered decision rules to maximize specificity with sensitivity set at 95%. We derived rules based on clinical data (R1) vs clinical dataDProstate Health Index (R3). We considered an “or”-logic rule combining clinical score and Prostate Health Index (R4), and a “2-step” rule using clinical data followed by risk stratification based on Prostate Health Index (R2). Rules were applied to a validation set, where values of R2-R4 vs R1 for specificity and sensitivity were evaluated. Results: We included 1,532 biopsies (n [ 610 discovery; n [ 922 validation) among 1,142 men. Grade reclassification was seen in 27% of biopsies (23% discovery, 29% validation). Among the discovery set, at 95% sensitivity, R2 yielded highest specificity at 27% vs 17% for R1. In the validation set, R3 had best performance vs R1 with Dsensitivity [ –4% and Dspecificity [ D6%. There was slight improvement for R3 vs R1 for confirmatory biopsy (AUC 0.745 vs R1 0.724, DAUC 0.021, 95% CI 0.002-0.041) but not for subsequent biopsies (DAUC –0.012, 95% CI –0.031-0.006). R3 did not have better discrimination vs R1 among the biopsy cohort overall (DAUC 0.007, 95% CI –0.007-0.020). Conclusions: Among active surveillance patients, using Prostate Health Index with clinical data modestly improved prediction of grade reclassification on confirmatory biopsy and did not improve prediction on subsequent biopsies.
Original language | English (US) |
---|---|
Pages (from-to) | 1037-1045 |
Number of pages | 9 |
Journal | Journal of Urology |
Volume | 208 |
Issue number | 5 |
DOIs | |
State | Published - Nov 1 2022 |
Keywords
- biomarkers
- prostatic neoplasms
- watchful waiting
ASJC Scopus subject areas
- Urology