Tool may predict prostate Ca overdiagnosis risk

Researchers at Fred Hutchinson Cancer Research Center and the University of Washington in Seattle have developed a personalized tool that they say can predict the likelihood of prostate cancer overdiagnosis.

The researchers created a nomogram that incorporates a patient’s age, PSA level, and Gleason score to determine the likelihood that screening-detected prostate cancer has been overdiagnosed.

The goal, said Roman Gulati, the study’s lead author, is to provide patients and clinicians with a tool that can help them better determine personalized treatment options.

“Men with screen-detected prostate cancer are making decisions about treatment based on limited information about the chances that their cancer has been overdiagnosed,” said Gulati, of Fred Hutchinson Cancer Research Center. “We think this is a useful tool for patients and their providers because it helps to tailor knowledge of the risks and benefits of different treatment choices to their individual situations.”

To develop the nomogram, the researchers created a virtual population model representing U.S. men aged 50 to 84 years from 1975 to 2005 and applied existing data on PSA levels, biopsy practices, and cancer diagnosis patterns to learn about cancer progression in patients with and without screening. The researchers then overlaid screening and biopsy patterns on the model to determine when the men would have been diagnosed with and without screening, and which would have died of other causes.

They developed a prediction model, which estimates that the likelihood of overdiagnosis ranges from 2.9% to 88.1% depending on patient age, PSA level, and Gleason score at diagnosis, as reported online in the Journal of the National Cancer Institute (Jan. 7, 2014).

While prostate cancer nomograms are not new, the current one is the first to determine the likelihood of overdiagnosis on an individual level, said Ruth Etzioni, PhD, the paper’s senior author.

“We’re trying to help patients who are the most likely to be overdiagnosed to recognize it and not be afraid to be more conservative in their treatment,” Dr. Etzioni said.

“This nomogram will provide clinically relevant information for both the provider and patient on which to base practical decision-making for newly diagnosed prostate cancer,” added Daniel Lin, MD, a University of Washington urologist. “We fully realize that many men do not need immediate treatment for their cancer and can be safely placed on an active surveillance protocol, and this important research will further clarify those who may avoid treatment versus those men who may benefit from attempted curative therapy.”

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