Modeling to Improve Prostate Cancer Outcomes Across Diverse Populations

改善不同人群前列腺癌预后的建模

基本信息

批准号：
9332349
负责人：
RUTH D ETZIONI
金额：
$ 103.66万
依托单位：
FRED HUTCHINSON CANCER RESEARCH CENTER
依托单位国家：
美国
项目类别：
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/9332349
关键词：
Address Age Area Calibration Cancer Control Cancer Detection Cancer Intervention and Surveillance Modeling Network Cancer Model 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 Funding Funding Opportunities 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 Prospective Studies Prostate Public Health Publications Research Personnel Research Priority Resources Risk Risk Marker 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 interdisciplinary approach men mortality novel novel diagnostics novel marker prevent process optimization programs prostate cancer model public health relevance racial disparity screening support tools surveillance strategy treatment strategy trend tumor progression virtual working group

项目摘要

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（由申请人提供）：前列腺癌是男性中最常见的癌症，七分之一的男性一生中都会经历前列腺癌的诊断。因此，自 20 世纪 90 年代初期以来，前列腺癌的治疗已经发生了巨大的变化，美国的前列腺癌死亡率下降了近一半。前列腺工作组 (PWG) 的成立是为了使用疾病模型来解释这些死亡率趋势。CISNET PWG 开发了三种前列腺癌自然史、检测和生存模型，并根据美国前列腺癌趋势对它们进行了校准。筛查和治疗的改变都减少了前列腺癌的死亡率。然而，必须制定政策来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，但不能在前瞻性研究中全部进行研究。的目标是利用和扩展 CISNET PWG 模型来确定量身定制的、有针对性的干预策略，在限制危害和成本的同时提供最大的益处。我们将确定是否可以通过使用新颖的分层方法进一步改进筛查，以及是否可以安全地限制危害。过度治疗这些方法将应用于可能需要修改策略的美国人群和国际癌症控制环境，我们将通过带有图形用户界面的在线计算器为决策者提供模型访问。目标 1：确定主动监测策略，在不增加进展为不可治愈疾病或死亡的风险的情况下最大限度地减少患者负担。目标 2：根据多基因风险和 45 岁基线 PSA 开发针对高风险男性的分层前列腺癌筛查方法。。目标 3：建立二级治疗策略及其影响和对人群前列腺癌控制的影响目标 4：确定是否可以通过使用分层筛查和治疗策略来减少前列腺癌死亡率的种族差异。目标 5：模块化模型以评估癌症控制。目标 6：开发在线计算器以支持患者与医生关于 PSA 筛查和治疗的决策和决策。这些目标对资助机会公告高度敏感，涉及 9 个目标优先领域中的 6 个领域，我们在前列腺建模、现有模型以及与提供大量临床专家的密切联系方面。用于模型验证和校准的高质量数据集使我们能够为有关如何最好地解决和控制这种男性最常见癌症的国家和国际对话做出独特的贡献。