Impact of Prostate Health Index Results for Prediction of Biopsy Grade Reclassification During Active Surveillance

No AccessJournal of UrologyAdult Urology1 Nov 2022Impact of Prostate Health Index Results for Prediction of Biopsy Grade Reclassification During Active SurveillanceThis article is commented on by the following:Editorial CommentEditorial Comment Christopher P. Filson, Kehao Zhu, Yijian Huang, Yingye Zheng, Lisa F. Newcomb, Sierra Williams, James D. Brooks, Peter R. Carroll, Atreya Dash, William J. Ellis, Martin E. Gleave, Michael A. Liss, Frances Martin, Jesse K. McKenney, Todd M. Morgan, Andrew A. Wagner, Lori J. Sokoll, Martin G. Sanda, Daniel W. Chan, and Daniel W. Lin Christopher P. FilsonChristopher P. Filson *Correspondence: Department of Urology, Emory University, School of Medicine, 1365 Clifton Rd. NE, 1st Floor, Building B, Atlanta, Georgia 30322 telephone: 404-778-4898; FAX: 404-778-4006; email: E-mail Address: [email protected] Department of Urology, Emory University School of Medicine, Atlanta, Georgia Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia More articles by this author , Kehao ZhuKehao Zhu Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington More articles by this author , Yijian HuangYijian Huang Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia More articles by this author , Yingye ZhengYingye Zheng Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington More articles by this author , Lisa F. NewcombLisa F. Newcomb https://orcid.org/0000-0003-3505-3754 Department of Urology, University of Washington, Seattle, Washington Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington More articles by this author , Sierra WilliamsSierra Williams Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author , James D. BrooksJames D. Brooks Department of Urology, Stanford University, Stanford, California More articles by this author , Peter R. CarrollPeter R. Carroll Department of Urology, University of California, San Francisco, California More articles by this author , Atreya DashAtreya Dash VA Puget Sound Health Care Systems, Seattle, Washington More articles by this author , William J. EllisWilliam J. Ellis Department of Urology, University of Washington, Seattle, Washington More articles by this author , Martin E. GleaveMartin E. Gleave Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada More articles by this author , Michael A. LissMichael A. Liss Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas More articles by this author , Frances MartinFrances Martin Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia More articles by this author , Jesse K. McKenneyJesse K. McKenney Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author , Todd M. MorganTodd M. Morgan Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Andrew A. WagnerAndrew A. Wagner Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author , Lori J. SokollLori J. Sokoll Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author , Martin G. SandaMartin G. Sanda Department of Urology, Emory University School of Medicine, Atlanta, Georgia Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia Co-senior authors. More articles by this author , Daniel W. ChanDaniel W. Chan Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland Co-senior authors. More articles by this author , and Daniel W. LinDaniel W. Lin Department of Urology, University of Washington, Seattle, Washington Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington Co-senior authors. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002852AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed whether Prostate Health Index results improve prediction of grade reclassification for men on active surveillance. Methods and Materials: We identified men in Canary Prostate Active Surveillance Study with Grade Group 1 cancer. Outcome was grade reclassification to Grade Group 2+ cancer. We considered decision rules to maximize specificity with sensitivity set at 95%. We derived rules based on clinical data (R1) vs clinical data+Prostate Health Index (R3). We considered an “or”-logic rule combining clinical score and Prostate Health Index (R4), and a “2-step” rule using clinical data followed by risk stratification based on Prostate Health Index (R2). Rules were applied to a validation set, where values of R2-R4 vs R1 for specificity and sensitivity were evaluated. Results: We included 1,532 biopsies (n = 610 discovery; n = 922 validation) among 1,142 men. Grade reclassification was seen in 27% of biopsies (23% discovery, 29% validation). Among the discovery set, at 95% sensitivity, R2 yielded highest specificity at 27% vs 17% for R1. In the validation set, R3 had best performance vs R1 with Δsensitivity = −4% and Δspecificity = +6%. There was slight improvement for R3 vs R1 for confirmatory biopsy (AUC 0.745 vs R1 0.724, ΔAUC 0.021, 95% CI 0.002-0.041) but not for subsequent biopsies (ΔAUC −0.012, 95% CI −0.031-0.006). R3 did not have better discrimination vs R1 among the biopsy cohort overall (ΔAUC 0.007, 95% CI −0.007-0.020). Conclusions: Among active surveillance patients, using Prostate Health Index with clinical data modestly improved prediction of grade reclassification on confirmatory biopsy and did not improve prediction on subsequent biopsies. References 1. . Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2018; 199(3):683-690. Link, Google Scholar 2. . Precision medicine in active surveillance for prostate cancer: development of the Canary–Early Detection Research Network Active Surveillance Biopsy Risk Calculator. Eur Urol. 2015; 68:1083-1088. Google Scholar 3. . A contemporary prostate biopsy risk calculator based on multiple heterogeneous cohorts. Eur Urol. 2018; 74(2):197-203. Crossref, Medline, Google Scholar 4. . 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Support: NIH/NCI Early Detection Research Network, U24 CA115102 (DWC). - PHI assay reagents were provided by Beckman Coulter, Inc. - American Cancer Society MRSG 18-015-01-CPHPS (CPF). - NIH U01 CA224255 (DL). - NIH U01 CA113913 (YH, LN, MGS and DWL). Conflict of Interest: Carroll: Alessa therapeutics Francis Medical Genomic Health/Exact. Ethics Statement: Participants consented to collection of research specimens under institutional regulatory board approval at all participating study sites, and this was approved by the central site institutional regulatory board (IRB No. 7122). © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHo M, Ross A and Eggener S (2023) Risk Stratification of Low-risk Prostate Cancer: Individualizing Care in the Era of Active SurveillanceJournal of Urology, VOL. 210, NO. 1, (38-45), Online publication date: 1-Jul-2023.Guidotti A, Lombardo R and De Nunzio C (2023) Long-term Outcomes Following Active Surveillance of Low-grade Prostate Cancer: A Population-based Study Using a Landmark Approach. Letter.Journal of Urology, VOL. 209, NO. 6, (1107-1108), Online publication date: 1-Jun-2023.Related articlesJournal of Urology10 Aug 2022Editorial CommentJournal of Urology10 Aug 2022Editorial Comment Volume 208Issue 5November 2022Page: 1037-1045Supplementary Materials PEER REVIEW REPORTS Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsbiomarkerswatchful waitingMetricsAuthor Information Christopher P. Filson Department of Urology, Emory University School of Medicine, Atlanta, Georgia Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia *Correspondence: Department of Urology, Emory University, School of Medicine, 1365 Clifton Rd. NE, 1st Floor, Building B, Atlanta, Georgia 30322 telephone: 404-778-4898; FAX: 404-778-4006; email: E-mail Address: [email protected] More articles by this author Kehao Zhu Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington More articles by this author Yijian Huang Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia More articles by this author Yingye Zheng Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington More articles by this author Lisa F. Newcomb Department of Urology, University of Washington, Seattle, Washington Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington More articles by this author Sierra Williams Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author James D. Brooks Department of Urology, Stanford University, Stanford, California More articles by this author Peter R. Carroll Department of Urology, University of California, San Francisco, California More articles by this author Atreya Dash VA Puget Sound Health Care Systems, Seattle, Washington More articles by this author William J. Ellis Department of Urology, University of Washington, Seattle, Washington More articles by this author Martin E. Gleave Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada More articles by this author Michael A. Liss Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas More articles by this author Frances Martin Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia More articles by this author Jesse K. McKenney Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author Todd M. Morgan Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Andrew A. Wagner Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author Lori J. Sokoll Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Martin G. Sanda Department of Urology, Emory University School of Medicine, Atlanta, Georgia Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia Co-senior authors. More articles by this author Daniel W. Chan Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland Co-senior authors. More articles by this author Daniel W. Lin Department of Urology, University of Washington, Seattle, Washington Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington Co-senior authors. More articles by this author Expand All Submitted December 10, 2021; accepted June 23, 2022; published July 5, 2022. Support: NIH/NCI Early Detection Research Network, U24 CA115102 (DWC). - PHI assay reagents were provided by Beckman Coulter, Inc. - American Cancer Society MRSG 18-015-01-CPHPS (CPF). - NIH U01 CA224255 (DL). - NIH U01 CA113913 (YH, LN, MGS and DWL). Conflict of Interest: Carroll: Alessa therapeutics Francis Medical Genomic Health/Exact. Ethics Statement: Participants consented to collection of research specimens under institutional regulatory board approval at all participating study sites, and this was approved by the central site institutional regulatory board (IRB No. 7122). Advertisement PDF downloadLoading ...