PCSM model predicts long-term mortality risk from prostate cancer

A recent study has shown the capacity of a novel prognostic model in predicting the long-term risk for prostate cancer-specific mortality (PCSM) following a prostate-specific antigen (PSA) test.

The researchers developed the prognostic model in the prostate cancer screening group (n=33,339) of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial (1993‒2001) and conducted an external validation in a Veterans Affairs (VA) population of patients (n=174,787) who underwent PSA testing from 2002 to 2006. Survival follow-up in these cohorts was updated through 2022.

The predicted outcome of the model was PCSM at a specified time point, with predictors such as race, PSA level, and family history of prostate cancer. For other-cause mortality, the predictors included age; BMI; smoking status; and presence of diabetes, stroke, or hypertension.

In the model development cohort, the area under the receiver operating characteristic curve (AUC) at 29.5 years from screening was 0.666 vs 0.643 (p<0.001) for a previously validated prostate biopsy risk model, the Prostate Biopsy Collaborative Group (PBCG).

In the external validation cohort, the AUC at 20 years from screening was 0.775 vs 0.749 for the PBCG model (p=0.031).

“This PCSM prognostic model was developed from long-term clinical trial data, was externally validated in a large national cohort, and may be used to improve interpretation of PSA results,” the researchers said. However, “the model may not be generalizable to more contemporary PSA screening practices given the periods studied.”