PREDICT Prostate: a new, sophisticated, prostate cancer prognostic tool

A new paper just published in PLOS Medicine describes the development of a new online tool called PREDICT Prostate.

The tool has been developed through the use of

  • Data from > 10,000 men recorded in a regional prostate cancer registry in the East of England (supposedly among the highest quality and most comprehensive data sets available both in the UK and internationally)
  • Outcomes data from the ProtecT trial (see Donovan et al.)
  • Outcomes data from a large US study (see Barocas et al.)

The data were then validated externally in a sample of > 2,500 prostate cancer patients in Singapore.

The detailed paper by Thurtle et al. describing the development of this new tool is available as a full-text article on line. A summary of the paper can also be found on the ScienceDaily web site.

The tool is for use by men who have been diagnosed with localized, non-metastatic forms of prostate cancer, and it can help men to make decisions about whether to choose some form of invasive treatment (e.g., surgery or radiation therapy) or whether they might be wise to simply monitor their disease (i.e., on active surveillance).

Detailed information about PREDICT Prostate is available on line. To use the actual tool yourself,  you need to enter the PREDICT Prostate web site and then click on the “Start Predict” button or the “Predict Prostate Tool” in the header bar.

The new PREDICT Prostate tool has similarities to the much older Kattan nonograms that one can find on the web site of the Memorial Sloan-Kettering Cancer Center (MSKCC), but it provides much more detailed information and is based on a more recent set of patient management data.

To use the tool, you would need to know the following:

  • Your age at diagnosis
  • Your PSA level at diagnosis
  • Your clinical T stage (i.e., T1, T2, T3, or T4)
  • Whether you have been admitted to a hospital in the past 2 years
  • Whether you know you have either of the BRCA1/2 genes (which are known to be a signal of risk for more aggressive forms of prostate cancer)
  • Either your Gleason score or you histological grade group
  • And ideally the number of biopsy cores you had taken and the number of those cores that had any cancer in them

The PREDICT Prostate system then uses these data to project all of the following:

  • Your overall survival if you decide to have conservative management (active surveillance)
  • Your overall survival if you decide to have radical treatment (surgery or radiation therapy)
  • The likelihood of erectile dysfunction at 3 years after diagnosis, by management type (if erectile function was normal at diagnosis)
  • The likelihood of incontinence at 3 years after diagnosis, by management type
  • The likelihood of  bowel dysfunction (defined as “bloody stools about half the time or more frequently) at 3 years after diagnosis, by management type

Now we should be clear that all prognostic tools of this type have to be used with caution. They are never “perfect” for an individual for all sorts of reasons. But what they do is that they provide the user with a “sophisticated estimate” of what is likely to happen over a period of time (10 and 15 years after initial diagnosis in the case of PREDICT Prostate) based on the available patient’s individualized information. Such sophisticated estimates can then be used by a patient, working with his doctors, to come to individualized decisions about what to do about his diagnosis and the risks and benefits of any particular decision.

Over the next few months we will be using this tool on a regular basis to see what it projects for appropriate patients who sign in on our social network and who are looking for help in their personal decision making. We will also be comparing the predictions of this tool to the predictions made by the older Kattan nomograms and the MSKCC male life expectancy calculator.

Editorial note: We would like to congratulate the research team on the development of this new tool, which — at least at first sight — appears to take us to a new level of sophistication in being able to understand the relative risks and benefits of conservative management as opposed to monitoring in the first-line treatment of localized prostate cancer.

9 Responses

  1. Hello Sitemaster, you have to click on the “Detailed Info Predict Prostate” and go to the site to use the tool. The “click here to use tool’ errors out for me anyway.

  2. Hmmm … You’re right. That’s weird since the tool is definitively at the link I have provided. See the corrected text above.

  3. And where is that link?

  4. Appears promising. I’ll be notifying others including some physicians.

  5. I agree 100% that this tool is likely much more accurate for lower risk men … as pointed out there is a warning to that effect on the nomogram. As a high risk patient at diagnosis, when I ran my own numbers from diagnosis, it suggested that ‘radical treatment’ only improved my 10 year survival by 6.7%; in other words with T3a, 4+4 disease I had only 7% worse survival outcome from not intervening with radical treatment. I find that very hard to accept.

    This may well be a very good tool for men with AS, low and intermediate risk disease. I am, however, leery to promote it widely, even with a warning on the Predict site itself since it may discourage men who are on the fence with hi-risk disease from intervening – that goes against my personal philosophy.

    Over the years I have supported several men with high risk and aggressive disease on diagnosis who have been reluctant to seek treatment. I think all of us advocates have. I do not want to provide greater justification to watch disease that could kill, and possibly quickly. On the other hand, I might recommend this tool to men who are candidates for AS, or who have low- or intermediate-risk prostate cancer; in other words I would have to know their disease demographics first.

  6. Dear Rick:

    If you haven’t done this, you might want to also run your own original diagnostic data thorough the male life expectancy calculator on the Memorial Sloan-Kettering Cancer Center web site and see what that tells you.

  7. Tx Sitemaster – I have seen the MSKCC nomogram previously; the results are all based on non-treatment.

    If conservative treatment in the PREDICT nomogram can be considered comparable to non-treatment, then it is way more optimistic @10 years suggesting 18% vs MSKCC Webcore’s 26% disease specific death – an almost 50% difference. However for 15 years PREDICT is more conservative, suggesting 38% while MSKCC indicates 33%. And the difference made by treatment is a lot higher for 15 years – 13% vs 7%.

    Does that make me rethink PREDICT is overly optimistic? … not sure. It probably makes me question the reliability of the nomogram for hi-risk disease all the more.

  8. Dear Rick:

    I think it is important to appreciate — when looking at the data from calculators like these — that it is the order of magnitudes that are important, not the precise numbers. Both calculators are telling you that high-risk men like you who are conservatively managed in some way have a roughly 20 to 25% risk of prostate cancer-specific mortality at 10 years and a roughly 35% risk at 15 years, and that the difference made by treatment is of the order of 10%.

    I understand that it can be hard to believe data like these, but if you go and look at the data from the SPCG-4 trial at about 10 years, at about 13 years, and most recently at about 23 years of follow-up, you will see that they actually correlate rather well with the calculators’ predictions.

    It is important to appreciate that 432/695 of the patients entered into the SPCG-4 trial are known to have had either intermediate- or high-risk prostate cancer, and that all of the patients had symptomatic disease, not prostate cancer defined by PSA data. It would almost certainly be possible for someone to analyze the data from the SPCG-4 trial to see how well they correlated with the data from the two calculators. Maybe there is a young resident or fellow at UCSF who would like to work with Bill-Axelson and her colleagues in Sweden and the teams at Cambridge and at MSKCC to do that!

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