Rule-based versus probabilistic selection for active surveillance using three definitions of insignificant prostate cancer.

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.

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