Annals of internal medicine · 2026
Predicting Long-Term Risk for Prostate Cancer Mortality Following a Prostate-Specific Antigen Screening Test: Prognostic Model Development and External Validation.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Lewicki Patrick, Jiang Ralph, Radhakrishnan Archana, Bryant Alex, Schipper Matthew, Morgan Todd M, Stensland Kristian
Аннотация
BACKGROUND: Despite the scale of prostate-specific antigen (PSA) testing for prostate cancer (PCa) screening, prediction models do not predict time-to-event end points or adjust for patient life expectancy.
OBJECTIVE: To develop, externally validate, and compare to existing tools a novel prognostic model for risk for prostate cancer-specific mortality (PCSM) after a PSA test.
DESIGN: Prognostic model development in the PCa screening group of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial; external validation in a Veterans Affairs (VA) population of patients undergoing PSA testing.
SETTING: United States. PLCO patients were enrolled from 1993 to 2001, and VA patients underwent PSA testing from 2002 to 2006. Survival follow-up was updated through 2022 in both cohorts.
PATIENTS: Male patients aged 55 to 74 years in the PLCO PCa screening group (n = 33 339) and the VA Healthcare System (n = 174 787).
MEASUREMENTS: The model's predicted outcome is PCSM at a specified time point; predictors included PSA level, family history of PCa, and race. Predictors of other-cause mortality included age; body mass index; smoking status; and presence of hypertension, diabetes, or stroke.
RESULTS: In the model development cohort, the area under the receiver operating characteristic curve (AUC) at 29.5 years from screening was 0.666 compared with 0.643 for a previously validated prostate biopsy risk model (Prostate Biopsy Collaborative Group [PBCG]) (P < 0.001). In the external validation cohort, the AUC at 20 years from screening was 0.776 for the PLCO model versus 0.749 for the PBCG model (P = 0.031).
LIMITATION: The model may not be generalizable to more contemporary PSA screening practices given the periods studied.
CONCLUSION: This PCSM prognostic model was developed from long-term clinical trial data, was externally validated in a large national cohort, and may be used to improve interpretation of PSA results.
PRIMARY FUNDING SOURCE: None.
OBJECTIVE: To develop, externally validate, and compare to existing tools a novel prognostic model for risk for prostate cancer-specific mortality (PCSM) after a PSA test.
DESIGN: Prognostic model development in the PCa screening group of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial; external validation in a Veterans Affairs (VA) population of patients undergoing PSA testing.
SETTING: United States. PLCO patients were enrolled from 1993 to 2001, and VA patients underwent PSA testing from 2002 to 2006. Survival follow-up was updated through 2022 in both cohorts.
PATIENTS: Male patients aged 55 to 74 years in the PLCO PCa screening group (n = 33 339) and the VA Healthcare System (n = 174 787).
MEASUREMENTS: The model's predicted outcome is PCSM at a specified time point; predictors included PSA level, family history of PCa, and race. Predictors of other-cause mortality included age; body mass index; smoking status; and presence of hypertension, diabetes, or stroke.
RESULTS: In the model development cohort, the area under the receiver operating characteristic curve (AUC) at 29.5 years from screening was 0.666 compared with 0.643 for a previously validated prostate biopsy risk model (Prostate Biopsy Collaborative Group [PBCG]) (P < 0.001). In the external validation cohort, the AUC at 20 years from screening was 0.776 for the PLCO model versus 0.749 for the PBCG model (P = 0.031).
LIMITATION: The model may not be generalizable to more contemporary PSA screening practices given the periods studied.
CONCLUSION: This PCSM prognostic model was developed from long-term clinical trial data, was externally validated in a large national cohort, and may be used to improve interpretation of PSA results.
PRIMARY FUNDING SOURCE: None.