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

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.

World journal of urology. 2023 Mar 15 [Epub ahead of print]

Michael Baboudjian, Alberto Breda, Thierry Roumeguère, Alessandro Uleri, Jean-Baptiste Roche, Alae Touzani, Vito Lacetera, Jean-Baptiste Beauval, Romain Diamand, Guiseppe Simone, Olivier Windisch, Daniel Benamran, Alexandre Fourcade, Gaelle Fiard, Camille Durand-Labrunie, Mathieu Roumiguié, Francesco Sanguedolce, Marco Oderda, Eric Barret, Gaëlle Fromont, Charles Dariane, Anne-Laure Charvet, Bastien Gondran-Tellier, Cyrille Bastide, Eric Lechevallier, Joan Palou, Alain Ruffion, Roderick C N Van Der Bergh, Alexandre Peltier, Guillaume Ploussard

Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France. ., Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium., Urology Department, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France., Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy., Division of Urology, Geneva University Hospitals, Geneva, Switzerland., Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France., Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France., Department of Urology, Toulouse University Hospital, Toulouse, France., Division of Urology, Department of Surgical Sciences - Urology, Città Della Salute E Della Scienza Di Torino - Molinette Hospital, University of Turin, Turin, Italy., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Department of Pathology, CHRU Tours, Tours, France., Department of Urology, U1151 Inserm-INEM, Hôpital Européen Georges-Pompidou, APHP, Paris University, Necker, Paris, France., Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France., Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France., Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France., Department of Urology, St. Antonius Hospital, Utrecht, the Netherlands.