Robust prediction of progression on active surveillance (AS) for prostate cancer can allow for risk-adapted protocols. To date, models predicting progression on AS have invariably used traditional statistical approaches.
We sought to evaluate whether a machine learning (ML) approach could improve prediction of progression on AS.
We performed a retrospective cohort study of patients diagnosed with very-low or low-risk prostate cancer between 1997 and 2016 and managed with AS at our institution. In the training set, we trained a traditional logistic regression (T-LR) classifier, and alternate ML classifiers (support vector machine, random forest, a fully connected artificial neural network, and ML-LR) to predict grade-progression. We evaluated model performance in the test set. The primary performance metric was the F1 score.
Our cohort included 790 patients. With a median follow-up of 6.29 years, 234 developed grade-progression. In descending order, the F1 scores were: support vector machine 0.586 (95% CI 0.579 - 0.591), ML-LR 0.522 (95% CI 0.513 - 0.526), artificial neural network 0.392 (95% CI 0.379 - 0.396), random forest 0.376 (95% CI 0.364 - 0.380), and T-LR 0.182 (95% CI 0.151 - 0.185). All alternate ML models had a significantly higher F1 score than the T-LR model (all p <0.001).
In our study, ML methods significantly outperformed T-LR in predicting progression on AS for prostate cancer. While our specific models require further validation, we anticipate that a ML approach will help produce robust prediction models that will facilitate individualized risk-stratification in prostate cancer AS.
Urologic oncology. 2021 Aug 28 [Epub ahead of print]
Madhur Nayan, Keyan Salari, Anthony Bozzo, Wolfgang Ganglberger, Gordan Lu, Filipe Carvalho, Andrew Gusev, Adam Schneider, Brandon M Westover, Adam S Feldman
Department of Urology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ., Department of Urology, Massachusetts General Hospital, Boston, Massachusetts; Broad Institute of Harvard and MIT, Cambridge, Massachusetts., Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada., Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts., Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.