Expanding inclusion criteria for active surveillance in intermediate-risk prostate cancer: a machine learning approach.

Male Humans Prostatic Neoplasms / surgery Prostate-Specific Antigen / analysis Retrospective Studies Magnetic Resonance Imaging Watchful Waiting Image-Guided Biopsy

Active surveillance Intermediate risk Machine learning Oncological outcomes Prostate cancer

Journal

World journal of urology

ISSN: 1433-8726

Titre abrégé: World J Urol

Pays: Germany

ID NLM: 8307716

Informations de publication

Date de publication:
May 2023

Historique:

received: 14 12 2022

accepted: 26 02 2023

medline: 18 5 2023

pubmed: 16 3 2023

entrez: 15 3 2023

Statut: ppublish

Résumé

To develop new selection criteria for active surveillance (AS) in intermediate-risk (IR) prostate cancer (PCa) patients. Retrospective study including patients from 14 referral centers who underwent pre-biopsy mpMRI, image-guided biopsies and radical prostatectomy. The cohort included biopsy-naive IR PCa patients who met the following inclusion criteria: Gleason Grade Group (GGG) 1-2, PSA < 20 ng/mL, and cT1-cT2 tumors. We relied on a recursive machine learning partitioning algorithm developed to predict adverse pathological features (i.e., ≥ pT3a and/or pN + and/or GGG ≥ 3). A total of 594 patients with IR PCa were included, of whom 220 (37%) had adverse features. PI-RADS score (weight:0.726), PSA density (weight:0.158), and clinical T stage (weight:0.116) were selected as the most informative risk factors to classify patients according to their risk of adverse features, leading to the creation of five risk clusters. The adverse feature rates for cluster #1 (PI-RADS ≤ 3 and PSA density < 0.15), cluster #2 (PI-RADS 4 and PSA density < 0.15), cluster #3 (PI-RADS 1-4 and PSA density ≥ 0.15), cluster #4 (normal DRE and PI-RADS 5), and cluster #5 (abnormal DRE and PI-RADS 5) were 11.8, 27.9, 37.3, 42.7, and 65.1%, respectively. Compared with the current inclusion criteria, extending the AS criteria to clusters #1 + #2 or #1 + #2 + #3 would increase the number of eligible patients (+ 60 and + 253%, respectively) without increasing the risk of adverse pathological features. The newly developed model has the potential to expand the number of patients eligible for AS without compromising oncologic outcomes. Prospective validation is warranted.

Identifiants

DOI: 10.1007/s00345-023-04353-8 PMID: 36920491

pubmed: 36920491

doi: 10.1007/s00345-023-04353-8

pii: 10.1007/s00345-023-04353-8

doi:

Substances chimiques

Prostate-Specific Antigen EC 3.4.21.77

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

1301-1308

Informations de copyright

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