PREDICT: prostate - a novel individualised prognostic model that estimates survival in newly diagnosed primary non-metastatic prostate cancer
BAUS ePoster online library. Thurtle D. Jun 26, 2018; 211341
Disclosure(s): The Urology Foundation Research Scholarship Funding support from The Evelyn Trust
Mr. David Thurtle
Mr. David Thurtle
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Abstract
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Introduction: Prognostic stratification is the cornerstone of management in non-metastatic prostate cancer (PCa). However, prognostic models bespoke to an individual are unavailable. To address this, we developed a novel prognostic model which contextualises PCa-specific mortality (PCSM) against other cause mortality for an individual, and estimates the survival benefit of treatment.

Methods: Using records from the National Cancer Registration and Analysis Service, data were collated for 10,089 men diagnosed with non-metastatic PCa between 2000-2010 in Eastern England. Models were developed against 10-year survival outcomes using patient, clinical and pathological parameters at diagnosis. Data were randomly split 70:30 into model development and validation cohorts. Discrimination and calibration were assessed by area under the curve(AUC) and Chi-Square goodness-of-fit respectively. A Singaporean cohort of 2,546 men represented an external validation dataset.

Results: Median follow-up was 9.8-years with 3,276 deaths (1,030 PCa-specific). Age, PSA, histological grade group, biopsy involvement, stage and primary treatment were each independent prognostic factors for PCSM. Age and comorbidity were prognostic for non-PCa mortality. Examples are shown in Figure 1. The model demonstrated good discrimination and calibration in the validation cohort with no significant difference in observed and predicted PCSM (p=0.16) or overall mortality (p=0.46) and AUC 0.81(95%CI: 0.78-0.83) and 0.83(95%CI: 0.81-0.84) respectively. In the Singapore cohort (417 deaths, median f/u 5.1-years) the model again performed well with <1% differences in observed and predicted mortality and AUC of 0.91 and 0.89 respectively.

Conclusion: PREDICT: Prostate is the first individualised prognostic model for non-metastatic PCa; it has significant potential to aid treatment decision-making.
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