To study whether probabilistic selection by the use of a nomogram could improve patient selection for active surveillance (AS) compared to the various sets of rule-based AS inclusion criteria currently used.
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We studied Dutch and Swedish patients participating in the European Randomized study of Screening for Prostate Cancer (ERSPC) We explored which men who were initially diagnosed with cT1-2, Gleason 6 (Gleason pattern ≤3 + 3) had histopathological indolent PCa at RP [defined as pT2, Gleason pattern ≤3 and tumour volume (TV) ≤0 5 or TV ≤ 1 3 ml, and TV no part of criteria (NoTV)] Rule-based selection was according to the Prostate cancer Research International: Active Surveillance (PRIAS), Klotz, and Johns Hopkins criteria An existing nomogram to define probability-based selection for AS was refitted for the TV1 3 and NoTV indolent PCa definitions
619 of 864 men undergoing RP had cT1-2, Gleason 6 disease at diagnosis and were analysed Median follow-up was 8 9 years 229 (37 %), 356 (58 %), and 410 (66 %) fulfilled the TV0 5, TV1 3, and NoTV indolent PCa criteria at RP Discriminating between indolent and significant disease according to area under the curve (AUC) was: TV0 5: 0 658 (PRIAS), 0 523 (Klotz), 0 642 (Hopkins), 0 685 (nomogram) TV1 3: 0 630 (PRIAS), 0 550 (Klotz), 0 615 (Hopkins), 0 646 (nomogram) NoTV: 0 603 (PRIAS), 0 530 (Klotz), 0 589 (Hopkins), 0 608 (nomogram)
The performance of a nomogram, the Johns Hopkins, and PRIAS rule-based criteria are comparable Because the nomogram allows individual trade-offs, it could be a good alternative to rigid rule-based criteria
World journal of urology 2015 Jul 10 [Epub ahead of print]
Lionne D F Venderbos, Monique J Roobol, Chris H Bangma, Roderick C N van den Bergh, Leonard P Bokhorst, Daan Nieboer, Rebecka Godtman, Jonas Hugosson, Theodorus van der Kwast, Ewout W Steyerberg
Department of Urology, Erasmus University Medical Center, Room Na1710, P O Box 2040, 3000 CA, Rotterdam, The Netherlands, l venderbos@erasmusmc nl