Risk calculators for men already on active surveillance

The Prostate Active Surveillance Study (PASS), initially funded by the Canary Foundation, is a multi-center research study for men  with low-risk disease who have chosen active surveillance (AS) to manage their prostate cancer. Active surveillance in PASS means closely monitoring men with prostate cancer and offering treatment if test results show the cancer is getting worse.

PASS has now been enrolling patients since 2008, so it hasn’t been going as long as studies at Sunnybrook in Canada or at places like UCSF and Johns Hopkins here in the USA, but … it is now enrolling patients at a total of 10 different sites around the country (after starting with six sites) and so it has been gradually accumulating a lot of data!

From a patient perspective, if you are actually on active surveillance and were initially diagnosed with a low-risk form of prostate cancer (i.e., a clinical stage of ≤ T2a and a Grade Group 1 or a Gleason score of ≤ 6 and a PSA level of < 10 ng/ml), then PASS-related data will now allow you to use one or other of two different on-line calculators to estimate

The accuracy of these two calculators appears to be reasonably high (but they are by no means perfect).  If you go to the web links for one or other of the two calculators listed above you can look at exempletive information regarding

  • The actual calculator
  • The clinical impact (i.e., how accurate the calculator is)
  • A sample patient report

If you want to be able to use the two calculators, you should first assemble all of the relevant information, which potentially includes:

  • The date of your initial biopsy
  • Your age
  • Your body mass index (BMI)
  • Your PSA levels over time since your initial diagnosis
  • Your prostate volume
  • The time since your initial diagnosis
  • The number of positive biopsy cores at the time of your biopsy with the most cancer
  • The total number of biopsy cores taken at your biopsy with the most cancer
  • The total number of biopsies you have had that showed NO cancer (since your initial diagnosis) — if any

Now we do need to be very clear — again — that these two calculators are only going to be of value for patients who meet diagnostic criteria for low- and very low-risk forms of prostate cancer and who are already on an active surveillance protocol. They will not work for men who have, for example, favorable, intermediate-risk prostate cancer and have chosen to go on active surveillance. Also, the introductory information about the use of these calculators by patients and others states clearly that

The Calculator is not to be used as a substitute for medical advice, diagnosis, or treatment of prostate cancer or any other medical problem. Use of the Calculator does not create an express or implied physician-patient relationship. Patients using the Calculator should address all questions to a physician or other healthcare provider.

Having said that, experienced patients who have been on AS for a while may find these calculators relatively easy to use. Men who are just starting on their journey on AS may want to discuss the use of these two calculators with their own doctors before they start to use them.

A recent paper by Cooperberg et al. in JAMA Oncology has reported on the use of  the “future progression” calculator. A straightforward commentary on this paper is also available on the MedPage Today web site. Dr. Cooperberg was partiularly careful to point out that Cooperberg pointed out that

less-invasive methods for assessing disease change — such as MRI or biomarkers — have yet to be shown to be able to replace standard tissue biopsies, which can be a barrier to active surveillance

One does wonder whether use of the new urine-based exome miRNA test (once it becomes widely available) might be able to help more men (and their urologists) consider AS as a reasonable clinical option for the initial management of low-risk forms of prostate cancer.

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