MP42-01 NO SIGNIFICANT IMPROVEMENT IN PATIENT OUTCOMES WHEN STRICTER ACTIVE SURVEILLANCE CRITERIA ARE APPLIED: A COMPARISON OF CONTEMPORARY ACTIVE SURVEILLANCE PROTOCOLS
Bibliographic record
Abstract
You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2015MP42-01 NO SIGNIFICANT IMPROVEMENT IN PATIENT OUTCOMES WHEN STRICTER ACTIVE SURVEILLANCE CRITERIA ARE APPLIED: A COMPARISON OF CONTEMPORARY ACTIVE SURVEILLANCE PROTOCOLS Maria Komisarenko, Narhari Timilshina, Shabbir Alibhai, Neil Fleshner, Alexandre Zlotta, Robert Hamilton, Girish Kulkarni, and Antonio Finelli Maria KomisarenkoMaria Komisarenko More articles by this author , Narhari TimilshinaNarhari Timilshina More articles by this author , Shabbir AlibhaiShabbir Alibhai More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Alexandre ZlottaAlexandre Zlotta More articles by this author , Robert HamiltonRobert Hamilton More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Antonio FinelliAntonio Finelli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1586AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is of growing interest as an alternative to radical treatment of low-risk prostate cancer (PCa). However various surveillance eligibility criteria and protocols exist with no consensus among stakeholders as to which criteria and protocol yield the best results for the most patients. Our aim is to discern between the outcomes of stricter versus more inclusive AS protocols and elucidate whether one provides more favorable outcomes for most patients. METHODS Between 1998-2014, 912 men enrolled in an AS program at Princess Margaret Cancer Centre (PM) between, with the following inclusion criteria: PSA ≤10, clinical stage ≤ cT2, Gleason sum ≤ 6, number of positive cores ≤ 3, no single core >50% involved, age ≤ 75 years. All patients who met the set criteria were retrospectively reviewed and assessed for entry eligibility into: Prostate Cancer Research International: Active Surveillance (PRIAS), John Hopkins Medical Institute (JH), University of Miami (UM), University of California, San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSK) and University of Toronto (UT). We also considered how the use of the various protocols would alter the timing and utilization of curative intervention. Univariate and multivariate statistics with Cox proportional hazards were used for comparisons. Logistic regression was used to determine any significant associations. All statistical analysis was done using SAS®. RESULTS From 912 men enrolled over the 16 year period, 712 met PM inclusion criteria. When JH, PRIAS, and UM criteria were applied to these patients 13.7%, 11.5%, and 8.8% of these men were excluded from AS. However, when we compared outcomes such as grade or volume progression there were no significant differences between men who met the PM criteria and those who met stricter AS criteria. No significant differences in PSA velocity, or the number of patient who proceeded to seek treatment (p>0.1). Time to treatment and follow-up were also not significantly different between men who were followed on a more inclusive versus more exclusive AS protocols. CONCLUSIONS While there are differences in inclusion criteria for AS, our results demonstrate that more strict criteria do not significantly improve patient outcomes when considering relative risk of Gleason Score upgrading, or biochemical failure after treatment. In an era of heightened awareness regarding over-diagnosis and overtreatment of prostate cancer, we believe that these stricter entry criteria should be reconsidered. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e508 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Komisarenko More articles by this author Narhari Timilshina More articles by this author Shabbir Alibhai More articles by this author Neil Fleshner More articles by this author Alexandre Zlotta More articles by this author Robert Hamilton More articles by this author Girish Kulkarni More articles by this author Antonio Finelli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".