Verbeek Jan F M, Nieboer Daan, Parker Chris, Kattan Michael W, Steyerberg Ewout W, Roobol Monique J
Department of Urology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
Department of Public Health, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
J Pers Med. 2019 Apr 22;9(2):19. doi: 10.3390/jpm9020019.
Prostate cancer (PCa) testing involves a complex individually based decision making process. It should consider competing risks from other comorbidities when estimating a survival benefit from the early detection of clinically significant (cs)PCa. We aimed to develop a prediction tool that provides concrete advice for the general practitioner (GP) on whether to refer a man for further assessment. We hereto combined the probability of detecting csPCa and the potential overall survival benefit from early detection and treatment. The PCa detection probabilities were derived from 3616 men enrolled in the Dutch arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Survival estimates were derived from 19,834 men from the Surveillance, Epidemiology, and End Results (SEER) registry, ERSPC, and Dutch life tables. Treatment benefit was estimated from the Prostate Cancer Intervention versus Observation Trial (PIVOT, = 731). The prediction of csPCa detection was based on prostate-specific antigen (PSA), age, %freePSA, and digital rectal examination (DRE). The life expectancy (LE) for patients with PCa receiving no treatment was adjusted for age and Charlson comorbidity index. A negative impact on LE and treatment benefit was found with higher age and more comorbidity. The proposed integrated approach may support triage at GP practices, as PCa is a heterogeneous disease in predominantly elderly men.
前列腺癌（PCa）检测涉及一个复杂的基于个体的决策过程。在评估早期发现临床显著（cs）PCa的生存获益时，应考虑来自其他合并症的竞争风险。我们旨在开发一种预测工具，为全科医生（GP）提供关于是否将男性患者转诊进行进一步评估的具体建议。为此，我们结合了检测csPCa的概率以及早期检测和治疗带来的潜在总体生存获益。PCa检测概率来自参与欧洲前列腺癌筛查随机研究（ERSPC）荷兰分部的3616名男性。生存估计来自监测、流行病学和最终结果（SEER）登记处、ERSPC以及荷兰生命表中的19834名男性。治疗获益是根据前列腺癌干预与观察试验（PIVOT，n = 731）估算的。csPCa检测的预测基于前列腺特异性抗原（PSA）、年龄、游离PSA百分比和直肠指检（DRE）。未接受治疗的PCa患者的预期寿命（LE）根据年龄和查尔森合并症指数进行了调整。发现年龄越大和合并症越多对LE和治疗获益有负面影响。由于PCa在主要为老年男性中是一种异质性疾病，所提出的综合方法可能有助于全科医疗实践中的分诊。
