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Post by Tony Crispino on Jan 25, 2014 8:34:41 GMT -8
This article comes out of the Fred Hutchenson Cancer Center in Seattle. This is a study to determine the risk for over diagnosis in low risk men. Have a look Risk of OverdiagnosisKey Points: - The model showed a 12.9% increase in risk of overdiagnosis with each 1-year increase in age, a 19.5% decrease for Gleason score ≥ 7 vs ≤ 6, and a 16.6% decrease for each 1-ng/mL increase in PSA at diagnosis.
- Predictions based on the nomogram show a dramatic increase in risk of overdiagnosis with increasing age; for example, among men with Gleason score ≤ 6 and PSA level of 4.0 to 4.9 ng/mL, risk increased from 11.6% for men aged 50 to 54 years to 59.9% for those aged 70 to 74 years and 83.4% for those aged 80 to 84 years.
Of course such a discussion of over diagnosis is taboo to many diagnosed with prostate cancer, this model shows that over diagnosis is considerably based upon age. This shows the risks are small for the younger men depending on PSA.
Tony |
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Post by Allen on Jan 25, 2014 12:22:01 GMT -8
Do you have the model? How did they deal with the covariance since both PSA and Gleason score increase with age, and PSA (generally) increases with GS? I wouldn't expect the age effect to be linear. There are competing risks with age: risk of more virulent disease increases with age, but death from other causes increases with age. It seems overdiagnosis is minimized at some point when the risk of a life-threatening cancer is high and life expectancy is still long enough to be killed by the cancer.
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Post by Tony Crispino on Jan 25, 2014 15:21:44 GMT -8
i know that Fred Hutchinson has quite a reputation on PCa modeling. I can ask Ruth Etzione for the details on it. She's listed on the "et al" side of this study. I'll send her an email on it and see if she can let me have the full paper. The last time she sent me something it sailed right over my head. I believe I copied you on that one called "Modeling grade progression in an active surveillance study."
Tony
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Post by Allen on Jan 25, 2014 21:44:57 GMT -8
Maybe she can answer the question, acknowledging that I'm only a kindergartener compared to her.
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Post by KC on Feb 4, 2014 7:11:01 GMT -8
In addition to the nomogram, there is a "rule of thumb" to predict PC overtreatment...
Rule of Thumb: if you have been diagnosed with mostly Gleason pattern 3 prostate cancer and have other low-risk case characteristics, and have made an aggressive treatment decision based on one PSA test and one biopsy, then you are probably at high risk for PC overtreatment.
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