Modeling Disease Trajectories for Castration-resistant Prostate Cancer Using Nationwide Population-based Data

Ventimiglia, Eugenio; Bill‐Axelson, Anna; Adolfsson, Jan; Aly, Markus; Eklund, Martin; Westerberg, Marcus; Stattin, Pär; Garmo, Hans

doi:10.1016/j.euros.2022.07.010

Cited by 1 publication

(5 citation statements)

References 19 publications

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“…In addition, we could verify good agreement between observed and simulated overall survival (eFigure 3 in Supplement 1). We have previously analyzed the robustness of estimates from state transition models using both sensitivity analyses and a comparative approach and found that these models provide stable estimates in terms of both calibration and prediction …”

Section: Discussionmentioning

confidence: 99%

“…The only way to achieve long-term follow-up in the current era is to combine observed data with appropriate modeling strategies. We therefore used previously validated simulation models for PCa disease trajectories 17 , 18 and estimations of life expectancy developed for this population. 6 Accurate estimation of life expectancy at diagnosis is essential for WW.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously analyzed the robustness of estimates from state transition models using both sensitivity analyses and a comparative approach and found that these models provide stable estimates in terms of both calibration and prediction. 5 , 6 , 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

“…The probability for transition to CRPC at each time step was then calculated based on the state transition model (eFigure 2 in Supplement 1 ). 17 The probability for no transition to CRPC was also estimated by this model. Among the potential dates for transition to CRPC, 1 was randomly selected proportional to the probability distribution defined by the model.…”

Section: Methodsmentioning

confidence: 99%

“…The microsimulation was performed as previously described, 5 , 9 , 17 , 18 and further details are provided in the eMethods and eFigure 2 in Supplement 1 . To increase precision, 100 replicates of each man were simulated.…”

Section: Methodsmentioning

confidence: 99%

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Natural History of Nonmetastatic Prostate Cancer Managed With Watchful Waiting

Ventimiglia,

Gedeborg,

Styrke

et al. 2024

JAMA Netw Open

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ImportanceIt is uncertain to what extent watchful waiting (WW) in men with nonmetastatic prostate cancer (PCa) and a life expectancy of less than 10 years is associated with adverse consequences.ObjectiveTo report transitions to androgen deprivation therapy (ADT), castration-resistant prostate cancer (CRPC), death from PCa, or death from other causes in men treated with a WW strategy.Design, Setting, and ParticipantsThis nationwide, population-based cohort study included men with nonmetastatic PCa diagnosed since 2007 and registered in the National Prostate Cancer Register of Sweden with WW as the primary treatment strategy and with life expectancy less than 10 years. Life expectancy was calculated based on age, the Charlson Comorbidity Index (CCI), and a drug comorbidity index. Observed state transition models complemented observed data to extend follow-up to more than 20 years. Analyses were performed between 2022 and 2023.ExposureNonmetastatic PCa.Main Outcomes and MeasuresTransitions to ADT, CRPC, death from PCa, and death from other causes were measured using state transition modeling.ResultsThe sample included 5234 men (median [IQR] age at diagnosis, 81 [79-84] years). After 5 years, 954 men with low-risk PCa (66.2%) and 740 with high-risk PCa (36.1%) were still alive and not receiving ADT. At 10 years, the corresponding proportions were 25.5% (n = 367) and 10.4% (n = 213), respectively. After 10 years, 59 men with low-risk PCa (4.1%) and 221 with high-risk PCa (10.8%) had transitioned to CRPC. Ten years after diagnosis, 1330 deaths in the low-risk group (92.3%) and 1724 in the high-risk group (84.1%) were from causes other than PCa.Conclusions and RelevanceThese findings suggest that the WW management strategy is appropriate for minimizing adverse consequences of PCa in men with a baseline life expectancy of less than 10 years.

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Section: Discussionmentioning

confidence: 99%