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Lorent M, Maalmi H, Tessier P, Supiot S, Dantan E, Foucher Y. Meta-analysis of predictive models to assess the clinical validity and utility for patient-centered medical decision making: application to the CAncer of the Prostate Risk Assessment (CAPRA). BMC Med Inform Decis Mak 2019; 19:2. [PMID: 30616621 PMCID: PMC6323757 DOI: 10.1186/s12911-018-0727-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Cancer of the Prostate Risk Assessment (CAPRA) score was designed and validated several times to predict the biochemical recurrence-free survival after a radical prostatectomy. Our objectives were, first, to study the clinical validity of the CAPRA score, and, second, to assess its clinical utility for stratified medicine from an original patient-centered approach. METHODS We proposed a meta-analysis based on a literature search using MEDLINE. Observed and predicted biochemical-recurrence-free survivals were compared to assess the calibration of the CAPRA score. Discriminative capacities were evaluated by estimating the summary time-dependent ROC curve. The clinical utility of the CAPRA score was evaluated according to the following stratified decisions: active monitoring for low-risk patients, prostatectomy for intermediate-risk patients, or radio-hormonal therapy for high risk patients. For this purpose, we assessed CAPRA's clinical utility in terms of its ability to maximize time-dependent utility functions (i.e. Quality-Adjusted Life-Years - QALYs). RESULTS We identified 683 manuscripts and finally retained 9 studies. We reported good discriminative capacities with an area under the SROCt curve at 0.73 [95%CI from 0.67 to 0.79], while graphical calibration seemed acceptable. Nevertheless, we also described that the CAPRA score was unable to discriminate between the three medical alternatives, i.e. it did not allow an increase in the number of life years in perfect health (QALYs) of patients with prostate cancer. CONCLUSIONS We confirmed the prognostic capacities of the CAPRA score. In contrast, we were not able to demonstrate its clinical usefulness for stratified medicine from a patient-centered perspective. Our results also highlighted the confusion between clinical validity and utility. This distinction should be better considered in order to develop predictive tools useful in practice.
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Affiliation(s)
- Marine Lorent
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
| | - Haïfa Maalmi
- Division of Clinical Epidemiology and Aging Research, Heidelberg University, Heidelberg, Germany
| | - Philippe Tessier
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de l’Ouest René Gauducheau, Saint Herblain, France
- INSERM UMR892, Nantes University, Nantes, France
| | - Etienne Dantan
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
| | - Yohann Foucher
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
- Nantes University Hospital, Nantes, France
- IRS2, SPHERE U1246, 22 boulevard Bénoni Goullin, 44200 Nantes, France
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Eminaga O, Fries J, Neiß S, Heitmann M, Wötzel F, Heidenreich A, Bruns C, Alakus H, Warnecke-Eberz U. The upregulation of hypoxia-related miRNA 210 in primary tumor of lymphogenic metastatic prostate cancer. Epigenomics 2018; 10:1347-1359. [DOI: 10.2217/epi-2017-0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: To show the association between the expression level of hsa-miR-210 (miR-210) and tumor progression in prostate cancer (PCa). Methods: Quantitative PCR was performed to measure miR-210 on 55 subjects with different tumor stages; our results were then validated using three external datasets. ANOVA and Tukey's post hoc analysis were performed for comparative analyses between different tumor stages. Using the transcriptome data from The Cancer Genome Atlas for CaP, the gene expression analyses were performed on experimentally validated target genes of miR-210 identified in Tarbase and miRWalk datasets. Results & conclusion: miR-210 was significantly higher in N1 PCa compared with nonmetastatic PCa, whereas the metastatic tumor revealed a lower expression level of miR-210 than the primary tumor.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany
- Department of Urology, Stanford University, Stanford, CA 94305, USA
| | - Jochen Fries
- Department of Pathology, University Hospital of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany
| | - Susanne Neiß
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Michaela Heitmann
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Fabian Wötzel
- Department of Pathology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, D- 48149 Muenster, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany
| | - Christiane Bruns
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Hakan Alakus
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Ute Warnecke-Eberz
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
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Campbell JM, Raymond E, O'Callaghan ME, Vincent AD, Beckmann KR, Roder D, Evans S, McNeil J, Millar J, Zalcberg J, Borg M, Moretti KL. Optimum Tools for Predicting Clinical Outcomes in Prostate Cancer Patients Undergoing Radical Prostatectomy: A Systematic Review of Prognostic Accuracy and Validity. Clin Genitourin Cancer 2017; 15:e827-e834. [DOI: 10.1016/j.clgc.2017.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/25/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
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Brajtbord JS, Leapman MS, Cooperberg MR. The CAPRA Score at 10 Years: Contemporary Perspectives and Analysis of Supporting Studies. Eur Urol 2017; 71:705-709. [DOI: 10.1016/j.eururo.2016.08.065] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/30/2016] [Indexed: 11/28/2022]
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Ceylan C, Tonyali S, Keles I. Impact of positive surgical margin on biochemical recurrence following radical prostatectomy in locally advanced prostate cancer. Kaohsiung J Med Sci 2016; 32:514-517. [PMID: 27742035 DOI: 10.1016/j.kjms.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/26/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022] Open
Abstract
This study aimed to determine the effect of surgical margin positivity on biochemical recurrence (BCR) in patients with locally advanced prostate cancer (PCa) who underwent radical retropubic prostatectomy (RRP). The medical records of all patients with locally advanced PCa that underwent RRP were retrospectively reviewed. Patient demographics, digital rectal examination findings, prostate biopsy Gleason score, prostate volume, pre- and post-treatment prostate-specific antigen (PSA) levels, definitive pathology Gleason score, surgical margin status, seminal vesicle invasion, perineural invasion, absence or presence of BCR, and the time to BCR were analyzed. The study included 130 patients. The final pathologic examination showed that seven (5.4%) patients had T3a disease and 123 (94.6%) had T3b disease. In all, 93 (71.5%) patients had a positive surgical margin [SM(+)], whereas 37 (28.5%) patients had a negative surgical margin [SM(-)]. Among the seven patients with pT3a disease, four (57.1%) had SM(+), whereas 89 (72.4%) of the 123 patients with pT3b disease had SM(-). BCR occurred in 11.8% (11 of 93) of patients with SM(+) and in 45.9% (17 of 37) of those with SM(-) (p < 0.001). Multivariate logistic regression analysis showed that SM(+) was the only significant predictor of BCR following RRP (relative risk, 0.163; 95% confidence interval (0.062-0.433); p < 0.001). SM(+) in RRP specimens is not always indicative of BCR in patients with locally advanced PCa. RRP should be considered an effective treatment choice for selected patients with locally advanced PCa, despite the associated high SM(+) rate.
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Affiliation(s)
- Cavit Ceylan
- Department of Urology, Clinic of Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Senol Tonyali
- Department of Urology, Clinic of Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
| | - Ibrahim Keles
- Department of Urology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey
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External validation of the CAPRA-S score to predict biochemical recurrence, metastasis and mortality after radical prostatectomy in a European cohort. J Urol 2014; 193:1970-5. [PMID: 25498570 DOI: 10.1016/j.juro.2014.12.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE The CAPRA-S score predicts prostate cancer recurrence based on pathological information from radical prostatectomy. To our knowledge CAPRA-S has never been externally validated in a European cohort. We independently validated CAPRA-S in a single institution European database. MATERIALS AND METHODS The study cohort comprised 14,532 patients treated with radical prostatectomy between January 1992 and August 2012. Prediction of biochemical recurrence, metastasis and cancer specific mortality by CAPRA-S was assessed by Kaplan-Meier analysis and the c-index. CAPRA-S performance to predict biochemical recurrence was evaluated by calibration plot and decision curve analysis. RESULTS Median followup was 50.8 months (IQR 25.0-96.0). Biochemical recurrence developed in 20.3% of men at a median of 21.2 months (IQR 7.7-44.9). When stratifying patients by CAPRA-S risk group, estimated 5-year biochemical recurrence-free survival was 91.4%, 70.4% and 29.3% in the low, intermediate and high risk groups, respectively. The CAPRA-S c-index to predict biochemical recurrence, metastasis and cancer specific mortality was 0.80, 0.85 and 0.88, respectively. Metastasis developed in 417 men and 196 men died of prostate cancer. CONCLUSIONS The CAPRA-S score was accurate when applied in a European study cohort. It predicted biochemical recurrence, metastasis and cancer specific mortality after radical prostatectomy with a c-index of greater than 0.80. The score can be valuable in regard to decision making for adjuvant therapy.
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Seo WI, Kang PM, Kang DI, Yoon JH, Kim W, Chung JI. Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): ability to predict cancer progression and decision-making regarding adjuvant therapy after radical prostatectomy. J Korean Med Sci 2014; 29:1212-6. [PMID: 25246738 PMCID: PMC4168173 DOI: 10.3346/jkms.2014.29.9.1212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/03/2014] [Indexed: 11/20/2022] Open
Abstract
The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessed through Kaplan Meier analysis and Cox proportional hazards regression test. Additionally, prediction probability was compared with preoperative CAPRA score by logistic regression analysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction ability for 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk group stratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for 3-yr progression free survival and 5-yr progression free survival (concordance index 0.74 vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictor concerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy.
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Affiliation(s)
- Won Ik Seo
- Department of Urology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Pil Moon Kang
- Department of Urology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Dong Il Kang
- Department of Urology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Jang Ho Yoon
- Department of Urology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Wansuk Kim
- Department of Urology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Jae Il Chung
- Department of Urology, Busan Paik Hospital, Inje University, Busan, Korea
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Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy. Eur Urol 2014; 65:1171-7. [DOI: 10.1016/j.eururo.2013.03.058] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/28/2013] [Indexed: 11/19/2022]
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9
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Sundi D, Wang VM, Pierorazio PM, Han M, Bivalacqua TJ, Ball MW, Antonarakis ES, Partin AW, Schaeffer EM, Ross AE. Very-high-risk localized prostate cancer: definition and outcomes. Prostate Cancer Prostatic Dis 2014; 17:57-63. [PMID: 24189998 PMCID: PMC3945953 DOI: 10.1038/pcan.2013.46] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/18/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Outcomes in men with National Comprehensive Cancer Network (NCCN) high-risk prostate cancer (PCa) can vary substantially-some will have excellent cancer-specific survival, whereas others will experience early metastasis even after aggressive local treatments. Current nomograms, which yield continuous risk probabilities, do not separate high-risk PCa into distinct sub-strata. Here, we derive a binary definition of very-high-risk (VHR) localized PCa to aid in risk stratification at diagnosis and selection of therapy. METHODS We queried the Johns Hopkins radical prostatectomy database to identify 753 men with NCCN high-risk localized PCa (Gleason sum 8-10, PSA >20 ng ml(-1), or clinical stage ≥T3). Twenty-eight alternate permutations of adverse grade, stage and cancer volume were compared by their hazard ratios for metastasis and cancer-specific mortality. VHR criteria with top-ranking hazard ratios were further evaluated by multivariable analyses and inclusion of a clinically meaningful proportion of the high-risk cohort. RESULTS The VHR cohort was best defined by primary pattern 5 present on biopsy, or ≥5 cores with Gleason sum 8-10, or multiple NCCN high-risk features. These criteria encompassed 15.1% of the NCCN high-risk cohort. Compared with other high-risk men, VHR men were at significantly higher risk for metastasis (hazard ratio 2.75) and cancer-specific mortality (hazard ratio 3.44) (P<0.001 for both). Among high-risk men, VHR men also had significantly worse 10-year metastasis-free survival (37% vs 78%) and cancer-specific survival (62% vs 90%). CONCLUSIONS Men who meet VHR criteria form a subgroup within the current NCCN high-risk classification who have particularly poor oncological outcomes. Use of these characteristics to distinguish VHR localized PCa may help in counseling and selection optimal candidates for multimodal treatments or clinical trials.
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Affiliation(s)
- D Sundi
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - V M Wang
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - P M Pierorazio
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - M Han
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - T J Bivalacqua
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - M W Ball
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - E S Antonarakis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - A W Partin
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - E M Schaeffer
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - A E Ross
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Abstract
Recently several new technologies for prostate imaging have been developed. The aim of these technologies was to improve the diagnosis of prostate cancer. Especially the transrectal ultrasound (TRUS) has been refined to the so-called enhanced ultrasound, as regular grey scale TRUS has limited ability to identify cancer lesions in the prostate. In several studies elastography has shown good capability to identify cancer lesions in the prostate as well as to absolutely increase the detection rate of randomized biopsies by up to 10 %.. Contrast-enhanced ultrasound shows varying results in the published literature with increased detection rates on the one hand and unchanged detection rates relative to randomized biopsy on the other hand. The online available ANNA/C-TRUS system shows detection rates with six targeted biopsies that are comparable to the published detection rates of randomized saturation biopsies. Direct systematic comparison to randomized biopsies is missing. The Histoscanning system currently provides the poorest data as no biopsy studies are available. Multicenter trials are mandatory for all new imaging technologies in order to implement them as standard into clinical practice.
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Affiliation(s)
- J Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite/ B.P.: 156, F-13273 Marseille, Frankreich.
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Pastuszak AW, Pearlman AM, Lai WS, Godoy G, Sathyamoorthy K, Liu JS, Miles BJ, Lipshultz LI, Khera M. Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy. J Urol 2013; 190:639-44. [PMID: 23395803 DOI: 10.1016/j.juro.2013.02.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Testosterone replacement therapy in men with prostate cancer is controversial, with concern that testosterone can stimulate cancer growth. We evaluated the safety and efficacy of testosterone in hypogonadal men with prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS We performed a review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy (treatment group) and 49 nonhypogonadal men with cancer treated with prostatectomy (reference group). There were 77 men with low/intermediate (nonhigh) risk cancer and 26 with high risk cancer included in the analysis. All men were treated with transdermal testosterone, and serum hormone, hemoglobin, hematocrit and prostate specific antigen were evaluated for more than 36 months. RESULTS Median (IQR) patient age in the treatment group was 61.0 years (55.0-67.0), and initial laboratory results included testosterone 261.0 ng/dl (213.0-302.0), prostate specific antigen 0.004 ng/ml (0.002-0.007), hemoglobin 14.7 gm/dl (13.3-15.5) and hematocrit 45.2% (40.4-46.1). Median followup was 27.5 months, at which time a significant increase in testosterone was observed in the treatment group. A significant increase in prostate specific antigen was observed in the high risk and nonhigh risk treatment groups with no increase in the reference group. Overall 4 and 8 cases of cancer recurrence were observed in treatment and reference groups, respectively. CONCLUSIONS Thus, testosterone therapy is effective and, while followed by an increase in prostate specific antigen, does not appear to increase cancer recurrence rates, even in men with high risk prostate cancer. However, given the retrospective nature of this and prior studies, testosterone therapy in men with history of prostate cancer should be performed with a vigorous surveillance protocol.
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