For men with newly diagnosed prostate cancer, we aimed to develop and validate a model to predict the risk of progression on active surveillance (AS), which could inform more personalised AS strategies. In total, 883 men from 3 European centres were used for model development and internal validation, and 151 men from a fourth European centre were used for external validation. Men with Cambridge Prognostic Group (CPG) 1-2 disease at diagnosis were eligible. The endpoint was progression to the composite endpoint of CPG3 disease or worse (≥CPG3). Model performance at 4 years was evaluated through discrimination (C-index), calibration plots, and decision curve analysis. The final multivariable model incorporated prostate-specific antigen (PSA), Grade Group, magnetic resonance imaging (MRI) score (Prostate Imaging Reporting & Data System (PI-RADS) or Likert), and prostate volume. Calibration and discrimination were good in both internal validation (C-index 0.742, 95% CI 0.694-0.793) and external validation (C-index 0.845, 95% CI 0.712-0.958). In decision curve analysis, the model offered net benefit compared to a 'follow-all' strategy at risk thresholds of ≥0.08 and ≥0.04 in development and external validation, respectively. In conclusion, our model demonstrated good accuracy and clinical utility in predicting the progression on AS at 4 years post-diagnosis. Men with lower risk predictions could subsequently be offered less-intense surveillance. Further external validation in larger cohorts is now required.
Journal of clinical medicine. 2022 Dec 27*** epublish ***
Alexander Light, Artitaya Lophatananon, Alexandra Keates, Vineetha Thankappannair, Tristan Barrett, Jose Dominguez-Escrig, Jose Rubio-Briones, Toufik Benheddi, Jonathan Olivier, Arnauld Villers, Kirthana Babureddy, Haitham Abdelmoteleb, Vincent J Gnanapragasam
Division of Urology, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK., Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK., Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK., Department of Urology, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain., Department of Urology, Lille University, 59000 Lille, France., Department of Urology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK.