Personalized Decision Making for Biopsies in Prostate Cancer Active Surveillance Programs

Area of Science:

• Oncology
• Biostatistics

Background:

• Active surveillance for low-risk prostate cancer involves frequent biopsies to monitor progression.
• Current fixed biopsy schedules can lead to patient non-compliance and delayed cancer detection.
• There is a need to balance the burden of biopsies with the risk of delayed progression detection.

Purpose of the Study:

• To personalize prostate cancer biopsy scheduling to optimize the balance between biopsy burden and detection delay.
• To develop a risk-based approach for determining biopsy timing in active surveillance programs.

Main Methods:

• Utilized joint models for time-to-event and longitudinal data on prostate-specific antigen (PSA) and digital rectal examination (DRE) measurements.
• Modeled patient-specific cumulative risk of cancer progression using historical data from the PRIAS program.
• Compared a personalized biopsy schedule with annual schedules via simulation.

Main Results:

• The personalized approach significantly reduced the median number of biopsies (4 vs. 10) compared to annual schedules.
• The delay in detecting cancer progression remained similar between personalized (0.7 years) and annual (0.5 years) schedules.
• A personalized strategy offers a better trade-off between biopsy frequency and diagnostic timeliness.

Conclusions:

• Personalized biopsy schedules improve the balance between monitoring burden and cancer progression detection for low-risk prostate cancer patients.
• This tailored approach enhances the efficiency of active surveillance programs.
• Personalized risk assessment can guide optimal biopsy timing in prostate cancer management.