Research Papers:
The management of active surveillance in prostate cancer: validation of the Canary Prostate Active Surveillance Study risk calculator with the Spanish Urological Association Registry
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Abstract
Ángel Borque-Fernando1,*, José Rubio-Briones2,*, Luis Mariano Esteban3, Argimiro Collado-Serra2, Yoni Pallás-Costa4, Pedro Ángel López-González5, Jorge Huguet-Pérez6, José Ignacio Sanz-Vélez7, Jesús Manuel Gil-Fabra1, Enrique Gómez-Gómez8, Cristina Quicios-Dorado9, Lluis Fumadó10, Sara Martínez-Breijo11 and Juan Soto-Villalba12, on behalf of the PIEM Active Surveillance Study Group
1Department of Urology, Hospital Universitario Miguel Servet, IIS-Aragón, Zaragoza, Spain
2Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
3Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, Zaragoza, Spain
4Department of Urology, Hospital de Manises, Valencia, Spain
5Department of Urology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
6Department of Urology, Hospital Clinic de Barcelona, Barcelona, Spain
7Department of Urology, Hospital General San Jorge, Huesca, Spain
8Department of Urology, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
9Department of Urology, Fundación Jimenez Díaz, Madrid, Spain
10Department of Urology, Hospital del Mar, Barcelona, Spain
11Department of Urology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
12Department of Urology, Hospital Universitario Puerta del Mar, Cádiz, Spain
*These authors have contributed equally to this work
Correspondence to:
Luis Mariano Esteban, email: [email protected]
Keywords: active surveillance; prostate cancer; reclassification; risk calculator; external validation
Received: August 10, 2017 Accepted: October 03, 2017 Published: October 24, 2017
ABSTRACT
The follow up of patients on active surveillance requires to repeat prostate biopsies. Predictive models that identify patients at low risk of progression or reclassification are essential to reduce the number of unnecessary biopsies. The aim of this study is to validate the Prostate Active Surveillance Study risk calculator (PASS-RC) in the multicentric Spanish Urological Association Registry of patients on active surveillance (AS), from common clinical practice.
Results: We find significant differences in age, PSA and clinical stage between our validation cohort and the PASS-RC generation cohort (p < .0001), with a reclassification rate of 10–22% on the follow-up Bx, no cancer was found in 43% of the first follow-up Bx. The calibration curve shows underestimation of real appearance of reclassification. The AUC is 0.65 (C.I.95%: 0.60–0.71). PDF and CUC do not suggest a specific cut-off point of clinical use.
Methods: We select 498 patients on AS with a minimum of one follow-up biopsy (Bx) from the 1,024 males registered by 36 Spanish centers recruiting patients on the Spanish Urological Association Registry on AS. PASS-RC external validation is carried by means of calibration curve and area under de ROC-curve (AUC), identifying cut-offs of clinical utility by probability density functions (PDF) and clinical utility curves (CUC).
Conclusions: In our first external validation of the PASS-RC we have obtained a moderate discrimination ability, although we cannot recommend cut-off points of clinical use. We suggest the exploration of new biomarkers and/or morpho-functional parameters from multiparametric magnetic resonance image, to improve those necessary tools on AS.
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