Table 3.
Prediction models for reclassification in active surveillance.
| Prediction Model | Development Cohort | Statistical Technique | Included Clinical Variables | Outcome | Performance | External Validation |
|---|---|---|---|---|---|---|
| Johns Hopkins [77,78] | 964 patients Gleason score ≤6 and at least two PSA measurements and at least 1 post-diagnosis biopsy | Dynamic Bayesian joint model | Repeated PSA and biopsy results | Gleason score ≥3 + 4 at radical prostatectomy | AUC = 0.74 (95%CI: 0.66–0.80) | None |
| Canary Prostate Active Surveillance Study [79,80] | 859 patients with Gleason score ≤6 at least 1 post-diagnosis biopsy | Logistic regression with generalised estimating equations | Most recent PSA; PSA change; age; time since the most recent prior biopsy; negative biopsy after biopsy; and the percent of positive cores (<34% vs. ≥34%) on the most recent prior biopsy | Gleason score ≥3 + 4 or an increase in percentage of cancer cores positive to ≥34% upon repeat biopsy | AUC = 0.72 | Johns Hopkins: AUC = 0.75 MSKCC: AUC = 0.68 PRIAS: AUC = 0.63 Toronto: AUC = 0.69 UCSF: AUC = 0.67 |
| Canary Prostate Active Surveillance Study [81] | 850 patients with Gleason score ≤6 and at least 1 post-diagnosis biopsy | Partly conditional Cox proportional hazards regression | PSA and prostate volume at diagnosis; PSA-kinetics; time since diagnosis; negative biopsy after diagnosis; maximum percent positive cores at diagnosis; and body mass index | No reclassification at 4 years | AUC = 0.70 (95%CI: 0.63–0.76) |
UCSF: AUC = 0.70 |
| PRIAS [82,83] | 7813 patients with Gleason score ≤6 | Dynamic Bayesian joint model | Repeated PSA and biopsy results; timing of prior biopsy; and age at inclusion | Gleason score ≥3 + 4 upon repeat biopsy | Time-dependent AUC = 0.62–0.69 | Johns Hopkins: AUC = 0.60–0.74 MSKCC: AUC = 0.58–0.75 Toronto: AUC = 0.64–0.79 UCSF: AUC = 0.62–0.74 KCL: AUC = 0.68–0.69 MUSIC: AUC = 0.60 |
| STRATCANS Model [84] | 883 patients with Gleason score ≤3 + 4 | Cox proportional hazards regression | At diagnosis: PSA; Gleason score; prostate volume; percent of positive cores; MRI PI-RADS score; age; and family history | Gleason score ≥4 + 3 or Gleason score ≥3 + 4 with PSA ≥ 10 upon repeat biopsy | C-index = 0.74 (95%CI: 0.69–0.79) | Cardiff: C-index = 0.85 |
PSA: prostate-specific antigen; MRI: magnetic resonance imaging; PI-RADS: Prostate Imaging Reporting and Data System; AUC: area under the curve; MSKCC: Memorial Sloan Kettering Cancer Centre; UCSF: University of California San Francisco; KCL: King’s College London; MUSIC: Michigan Urological Surgery Improvement Collaborative.