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Expanding inclusion criteria for active surveillance in intermediate-risk prostate cancer: a machine learning approach

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To develop new selection criteria for active surveillance (AS) in intermediate-risk (IR) prostate cancer (PCa) patients.

Methods

Retrospective study including patients from 14 referral centers who underwent pre-biopsy mpMRI, image-guided biopsies and radical prostatectomy. The cohort included biopsy-naive IR PCa patients who met the following inclusion criteria: Gleason Grade Group (GGG) 1–2, PSA < 20 ng/mL, and cT1-cT2 tumors. We relied on a recursive machine learning partitioning algorithm developed to predict adverse pathological features (i.e., ≥ pT3a and/or pN + and/or GGG ≥ 3).

Results

A total of 594 patients with IR PCa were included, of whom 220 (37%) had adverse features. PI-RADS score (weight:0.726), PSA density (weight:0.158), and clinical T stage (weight:0.116) were selected as the most informative risk factors to classify patients according to their risk of adverse features, leading to the creation of five risk clusters. The adverse feature rates for cluster #1 (PI-RADS ≤ 3 and PSA density < 0.15), cluster #2 (PI-RADS 4 and PSA density < 0.15), cluster #3 (PI-RADS 1–4 and PSA density ≥ 0.15), cluster #4 (normal DRE and PI-RADS 5), and cluster #5 (abnormal DRE and PI-RADS 5) were 11.8, 27.9, 37.3, 42.7, and 65.1%, respectively. Compared with the current inclusion criteria, extending the AS criteria to clusters #1 + #2 or #1 + #2 + #3 would increase the number of eligible patients (+ 60 and + 253%, respectively) without increasing the risk of adverse pathological features.

Conclusions

The newly developed model has the potential to expand the number of patients eligible for AS without compromising oncologic outcomes. Prospective validation is warranted.

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Data availability

Data are available upon request to the corresponding author.

Code availability

None.

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Funding

The study was not funded.

Author information

Author notes

  1. Michael Baboudjian and Alberto Breda authors contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France

    Michael Baboudjian, Alae Touzani, Jean-Baptiste Beauval & Guillaume Ploussard

  2. Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France

    Michael Baboudjian & Cyrille Bastide

  3. Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France

    Michael Baboudjian, Anne-Laure Charvet, Bastien Gondran-Tellier & Eric Lechevallier

  4. Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain

    Michael Baboudjian, Alberto Breda, Alessandro Uleri, Francesco Sanguedolce & Joan Palou

  5. Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium

    Thierry Roumeguère, Romain Diamand & Alexandre Peltier

  6. Urology Department, Clinique Saint-Augustin, Bordeaux, France

    Jean-Baptiste Roche

  7. Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy

    Vito Lacetera

  8. Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy

    Guiseppe Simone

  9. Division of Urology, Geneva University Hospitals, Geneva, Switzerland

    Olivier Windisch & Daniel Benamran

  10. Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France

    Alexandre Fourcade

  11. Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France

    Gaelle Fiard

  12. Department of Urology, Toulouse University Hospital, Toulouse, France

    Camille Durand-Labrunie & Mathieu Roumiguié

  13. Division of Urology, Department of Surgical Sciences - Urology, Città Della Salute E Della Scienza Di Torino - Molinette Hospital, University of Turin, Turin, Italy

    Marco Oderda

  14. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    Eric Barret

  15. Department of Pathology, CHRU Tours, Tours, France

    Gaëlle Fromont

  16. Department of Urology, U1151 Inserm-INEM, Hôpital Européen Georges-Pompidou, APHP, Paris University, Necker, Paris, France

    Charles Dariane

  17. Service d’urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France

    Alain Ruffion

  18. Equipe 2, Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, Lyon, France

    Alain Ruffion

  19. Department of Urology, St. Antonius Hospital, Utrecht, the Netherlands

    Roderick C. N. Van Der Bergh

Authors
  1. Michael Baboudjian
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  2. Alberto Breda
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  3. Thierry Roumeguère
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  4. Alessandro Uleri
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  5. Jean-Baptiste Roche
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  6. Alae Touzani
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  7. Vito Lacetera
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  8. Jean-Baptiste Beauval
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  9. Romain Diamand
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  10. Guiseppe Simone
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  11. Olivier Windisch
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  12. Daniel Benamran
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  13. Alexandre Fourcade
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  14. Gaelle Fiard
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  15. Camille Durand-Labrunie
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  16. Mathieu Roumiguié
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  17. Francesco Sanguedolce
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  18. Marco Oderda
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  19. Eric Barret
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  20. Gaëlle Fromont
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  21. Charles Dariane
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  22. Anne-Laure Charvet
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  23. Bastien Gondran-Tellier
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  24. Cyrille Bastide
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  25. Eric Lechevallier
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  26. Joan Palou
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  27. Alain Ruffion
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  28. Roderick C. N. Van Der Bergh
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  29. Alexandre Peltier
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  30. Guillaume Ploussard
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Contributions

Study concept and design: BP. Acquisition of data: AB, TR, AU, J-BR, AT, VL, J-BB, RD, GS, OW, DB, AF, GF, CD-L, MR, FS, MO, EB, GF, CD, A-LC, BG-T, CB, EL, JP, AR, RCNVDB, AP. Analysis and interpretation of data: MB, UP. Drafting of the manuscript: MB, GP. Critical revision of the manuscript for important intellectual content: AB, TR, AU, J-BR, AT, VL, J-BB, RD, GS, OW, DB, AF, GF, CD-L, MR, FS, MO, EB, GF, CD, A-LC, BG-T, CB, EL, JP, AR, RC VDB, AP. Statistical analysis: BU.

Corresponding author

Correspondence to Michael Baboudjian.

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The authors report no conflict of interest.

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All procedures performed in this study were in approval with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patient consent was not required due to the study design (retrospective).

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Baboudjian, M., Breda, A., Roumeguère, T. et al. Expanding inclusion criteria for active surveillance in intermediate-risk prostate cancer: a machine learning approach. World J Urol 41, 1301–1308 (2023). https://doi.org/10.1007/s00345-023-04353-8

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  • DOI: https://doi.org/10.1007/s00345-023-04353-8

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