Modeling to Improve Prostate Cancer Outcomes Across Diverse Populations

改善不同人群前列腺癌预后的建模

• 批准号: 9132188
• 负责人: RUTH D ETZIONI
• 金额: $ 106.68万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9132188
• 关键词: Address; Age; Area; Calibration; Cancer Control; Cancer Detection; Cancer Intervention and Surveillance Modeling Network; Caribbean region; Cessation of life; Clinical; Conflict (Psychology); Consensus; Continuity of Patient Care; Country; Data Quality; Data Set; Detection; Development; Diagnostic tests; Disease; Disease Outcome; Disease model; Drops; Europe; European; Funding; Funding Opportunities; Health; Individual; International; Intervention; Malignant Neoplasms; Malignant neoplasm of prostate; Modeling; Natural History; Newly Diagnosed; Outcome; PSA screening; Patients; Pattern; Physicians; Policies; Policy Maker; Population; Population Heterogeneity; Positioning Attribute; Process; Prospective Studies; Prostate; Public Health; Publications; Research Personnel; Research Priority; Resources; Risk; Route; Screening for Prostate Cancer; Source; Specific qualifier value; Stratification; Time; Validation; Work; base; cancer diagnosis; cancer risk; cost; disorder control; disorder risk; experience; genetic signature; graphical user interface; health disparity; high risk; high risk men; improved; man; men; mortality; novel; novel diagnostics; novel marker; prevent; programs; prostate cancer model; racial disparity; screening; support tools; surveillance strategy; treatment strategy; trend; tumor progression; virtual; working group

 DESCRIPTION (provided by applicant): Prostate cancer is the most common cancer in men. In the US, 1 in 7 men will experience a prostate cancer diagnosis in his lifetime. Identifying ways to reduce the burden of prostate cancer is therefore a top research priority. Management of prostate cancer has changed dramatically since the advent and widespread dissemination of the PSA test. Since the early 1990s, prostate cancer mortality in the US has dropped by almost half. The CISNET Prostate Working Group (PWG) was formed to use disease modeling to explain these mortality trends. The CISNET PWG has developed three models of prostate cancer natural history, detection, and survival and calibrated them against US prostate cancer trends. Results indicate that both screening and treatment changes have reduced prostate cancer deaths. However, policies must be tailored to limit harms and costs associated with overdiagnosis and overtreatment. Different approaches for doing this have been proposed but cannot all be investigated in prospective studies. The objective of this application is to utilize and extend the CISNET PWG models to identify tailored and targeted intervention strategies that offer the most benefit while limiting harms and costs. We will determine whether we can improve screening further by using novel stratification approaches and also whether we can safely limit harms of overtreatment by judicious choices of primary and secondary therapies. These approaches will be applied in the US population and in international cancer control settings that may require modified strategies. We will provide decision makers with model access via online calculators with graphical user interfaces. Our specific aims are: Aim 1: Identify active surveillance strategies that minimize patient burden without increasing risks of progression to non-curable disease or death. Aim 2: Develop stratified approaches to prostate cancer screening that target high-risk men based on polygenic risk and baseline PSA at age 45. Aim 3: Model secondary treatment strategies, their impact, and implications for population prostate cancer control. Aim 4: Determine whether racial disparities in prostate cancer mortality can be reduced by using stratified screening and treatment strategies. Aim 5: Modularize models to evaluate cancer control programs in non-US populations and collaborate with investigators in the UK and the Caribbean to develop policies for their populations and resources. Aim 6: Develop online calculators to support patient-physician decisions and policymaker deliberations about PSA screening and treatment for localized prostate cancer. These aims are highly responsive to the funding opportunity announcement, addressing 6 of the 9 targeted priority areas. Our cumulative expertise in prostate modeling, our existing models, and our close ties with clinical experts who provide access to large, high-quality datasets for model validation and calibration position us well to uniquely contribute to the national and international dialogue about how best to address and control this most common cancer in men.

 描述（由适用提供）：前列腺癌是男性最常见的癌症。在美国，七分之一的男性将在他的一生中经历前列腺癌的诊断。识别方法 因此，减少前列腺癌的燃烧是最重要的研究重点。自PSA检验的进步和宽度传播以来，前列腺癌的管理发生了巨大变化。自1990年代初以来，美国的前列腺癌死亡率下降了几乎一半。形成了Cisnet前列腺工作组（PWG）来使用疾病建模来解释这些死亡率趋势。 CISNET PWG开发了三种模型的前列腺癌自然史，检测和生存，并针对美国前列腺癌​​趋势进行了校准。结果表明，筛查和治疗变化都减少了前列腺癌的死亡。但是，必须对政策进行量身定制，以限制与过度诊断和过度治疗相关的危害和成本。已经提出了不同的方法，但不能全部研究前瞻性研究。该应用程序的目的是利用和扩展CISNET PWG模型来确定量身定制和有针对性的干预策略，这些策略在限制危害和成本的同时提供了最大的好处。我们将确定是否可以通过使用新型分层方法进一步改善筛查，以及是否可以通过明智的基本和次级疗法的明智选择安全地限制过度处理的危害。这些方法将应用于美国人口和可能需要修改策略的国际癌症控制环境中。我们将通过图形用户界面通过在线计算器为决策者提供模型访问。我们的具体目的是：目标1：确定积极的监视策略，这些策略可最大程度地减少患者的灼伤而不会增加非可抗病疾病或死亡的风险。 AIM 2：开发的分层方法来针对45岁时基于多基因风险和基线PSA靶向高危男性。AIM3：模型二级治疗策略，其对目标的影响和影响4：确定前列腺癌死亡率中的种族差异是否可以通过使用分层筛查和治疗策略来降低前列腺癌死亡率。目标5：模块化模型，以评估非美国人群中的癌症控制计划，并与英国和加勒比海的研究人员合作制定人口和资源的政策。目标6：开发在线计算器，以支持患者 - 医学家的决策以及对PSA筛查和治疗局部前列腺癌的审议。这些目标对融资机会公告的响应高度敏感，解决了9个目标优先领域中的6个。我们在前列腺建模，现有模型以及与临床专家的紧密联系方面的累积专业知识，这些专家提供了访问大型高质量数据集的模型验证和校准位置，以便我们为如何最好地解决男性最常见癌症的国家和国际对话，从而唯一地为国家和国际对话做出贡献。