2019/07/12 by Anirudh Tomer, Dimitris Rizopoulos, Tomer, Anirudh +9
Biochemistry, Genetics and Molecular Biology · Medicine · #Applications (stat.AP) #Cancer Genomics and Diagnostics #Colorectal Cancer Screening and Detection #FOS: Computer and information sciences #Methodology (stat.ME) #Prostate Cancer Diagnosis and Treatment
paper · pdf · doi:10.48550/arxiv.1907.05621
openalex publication_date 2019/07/12 · openalex created_date 2022/07/19 · openalex updated_date 2026/07/28
Background: Low-risk prostate cancer patients enrolled in active surveillance\nprograms commonly undergo biopsies for examination of cancer progression.\nBiopsies are conducted as per a fixed and frequent schedule (e.g., annual\nbiopsies). Since biopsies are burdensome, patients do not always comply with\nthe schedule, which increases the risk of delayed detection of cancer\nprogression.\n Objective: Our aim is to better balance the number of biopsies (burden) and\nthe delay in detection of cancer progression (less is beneficial), by\npersonalizing the decision of conducting biopsies.\n Data Sources: We use patient data of the world's largest active surveillance\nprogram (PRIAS). It enrolled 5270 patients, had 866 cancer progressions, and an\naverage of nine prostate-specific antigen (PSA) and five digital rectal\nexamination (DRE) measurements per patient.\n Methods: Using joint models for time-to-event and longitudinal data, we model\nthe historical DRE and PSA measurements, and biopsy results of a patient at\neach follow-up visit. This results in a visit and patient-specific cumulative\nrisk of cancer progression. If this risk is above a certain threshold, we\nschedule a biopsy. We compare this personalized approach with the currently\npracticed biopsy schedules via an extensive and realistic simulation study,\nbased on a replica of the patients from the PRIAS program.\n Results: The personalized approach saved a median of six biopsies (median: 4,\nIQR: 2-5), compared to the annual schedule (median: 10, IQR: 3-10). However,\nthe delay in detection of progression (years) is similar for the personalized\n(median: 0.7, IQR: 0.3-1.0) and the annual schedule (median: 0.5, IQR:\n0.3-0.8).\n Conclusions: We conclude that personalized schedules provide substantially\nbetter balance in the number of biopsies per detected progression for men with\nlow-risk prostate cancer.\n