JSM 2005 - Toronto

Abstract #304800

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Activity Number: 481
Type: Contributed
Date/Time: Thursday, August 11, 2005 : 8:30 AM to 10:20 AM
Sponsor: Biometrics Section
Abstract - #304800
Title: Changepoint Modeling To Evaluate a Rule for Prostate-specific Antigen (PSA) Failure when the Rule Is Defined as Three Consecutive PSA Rises
Author(s): Carine Bellera*+ and James Hanley and Lawrence Joseph and Peter Albertsen and Juanita Crook
Companies: McGill University and McGill University and McGill University and University of Connecticut and Ottawa Regional Cancer Center
Address: Dept. Epidemiology & Biostatistics, Montreal, PQ, H3A 1A2, Canada
Keywords: Consecutive rises ; changepoint ; sensitivity ; hierarchical model ; prostate cancer ; PSA
Abstract:

Prostate-specific antigens (PSA) are used to monitor prostate cancer recurrence after radiotherapy. The American Society for Therapeutic Radiology and Oncology defines biochemical failure as three consecutive PSA rises. The rule is widely used, but criticized for its low classification performance due to measurement and short-term biological variations. It has not been formally evaluated. We evaluate the sensitivity and specificity of the rule and variations of it. We use the distribution of sample arrangements for runs-up and 470 PSA series from a community-based study. Using a hierarchical changepoint model, we estimate the distribution and variability of the true series. From the estimated profiles, we generate serial measurements that are a combination of true PSA growth rates and measurement variation and estimate the sensitivity as a function of measurement frequency and follow-up length. Estimation of the true PSA profiles using hierarchical models allows distinguishing true PSA rises from random ones; it allows one to accurately evaluate rules for PSA failures that use consecutive PSA rises.

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