Dr. Ashutosh Tewari, with the Josephine Ford Cancer Center (Detroit, MI) worked with investigators at ANNs in CaP (Denver, CO) to retrospectively identify a cohort of 1,611 patients with clinically localized prostate cancer as well as 4,538 age, race, and co-morbidity (those with additional diseases) matched controls. Based on demographic and clinical variables, propensity risk scoring was used to develop survival probability estimates for both patients and controls. Because the calculator, and the companion look-up tables published in the April issue of the Journal of Urology, provide a comparison with men with similar characteristics but who do not have prostate cancer, users receive a realistic estimate of the impact of prostate cancer on long-term survival.
Prostate cancer is the most common solid-organ male malignancy diagnosed in the United States, with an estimated 189,000 new cases each year. Currently, African-American men have the highest incidence of prostate cancer in the world (137 per 100,000 per year), and are 2.5 times as likely to die as whites. While the reason for this is not known, some research suggests that black men are often diagnosed at later disease stages. Dr. Tewari adds, "Our research indicates that African-American men also tend to undergo less aggressive treatment than whites, and additional studies by our group suggest that if they received the same treatments, their prostate cancer survival rates would be much closer to those of whites." The study also showed that a man's level of co-morbidities can have as much or more of an impact on his chances of long-term survival than his prostate cancer alone.
This new prostate cancer survival model is the most comprehensive to date because it provides an estimate of the likelihood of survival taking into account a patient's age, race, comorbities, and treatment type. According to Dr. Tewari, "While the study was not a randomized controlled trial comparing surgery, radiation therapy, and watchful waiting, the method we used has been shown to eliminate much of the bias introduced with a non-randomized study design. And the inclusion of a large, matched control group is a great strength of our study."
While the study, which was awarded a first prize by the American Urological Association, adds to the knowledge of how co-morbidities and race affect the long-term survival of men with prostate cancer, an additional benefit is that it prompted Dr. Tewari's team to ask and seek answers to new questions: Why do black men receive less aggressive treatment than whites? Are black men choosing less aggressive treatment themselves or are their doctors suggesting the treatment? And, finally, is it worthwhile for men with additional diseases to treat their prostate cancer?
No personal information is collected and patient privacy is respected. The site does not promote particular doctors or specific treatments.
About ANNs in CaP
The prostatecalculator.org web site was produced by the Artificial Neural Networks in Prostate Cancer (ANNs in CaP) Project. Based in Denver, Colo., this research collaborative is headed by leading prostate-cancer expert Dr. E. David Crawford and funded by the Institute for Clinical Research at the Veterans Affairs Medical Center in Washington, D.C. Under the guidance of Dr. Crawford, national and international authorities in the fields of prostate cancer and artificial intelligence are working together to investigate the use of ANNs in the diagnosis, prognosis, and treatment of prostate cancer. The project web site is located at www.annsincap.org.
Journal
The Journal of Urology