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Validation of algorithms to detect distant metastases in men with prostate cancer using routine registry data in Denmark.

Ehrenstein V, Hernandez RK, Maegbaek ML, Kahlert J, Nguyen-Nielsen M, Nørgaard M, Liede A - Clin Epidemiol (2015)

Bottom Line: Among patients with prostate cancer, diagnostic codes for bone metastases in the Danish National Registry of Patients have a sensitivity of 44%.Adding antiresorptive treatment to the algorithm did not improve PPV.All negative predictive values approached 1.00.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Objective: Among patients with prostate cancer, diagnostic codes for bone metastases in the Danish National Registry of Patients have a sensitivity of 44%. In an attempt to improve the sensitivity of registry-based identification of metastases from prostate cancer, we tested a series of algorithms, combining elevated prostate-specific antigen (PSA) levels, use of antiresorptive therapy, and performed bone scintigraphy.

Patients and methods: We randomly selected 212 men diagnosed with prostate cancer in 2005-2010 in the Central Denmark Region with prespecified PSA values, antiresorptive therapy, and bone scintigraphy who did not have a registry-based diagnostic code indicating presence of distant metastases. We defined three candidate algorithms for bone metastases: 1) PSA >50 μg/L and bone scintigraphy, 2) PSA >50 μg/L and antiresorptive therapy, and 3) PSA ≤50 μg/L with antiresorptive therapy or bone scintigraphy. An algorithm for distant metastasis site other than bone was defined as PSA >50 μg/L alone. Medical chart review was used as the reference standard to establish the presence or absence of metastases. Validity was expressed as a positive predictive value (PPV) or a negative predictive value, based on whether the algorithms correctly classified metastases compared with the reference standard.

Results: We identified 113 men with evidence of metastases according to the candidate algorithms, and 99 men without evidence of metastases according to the candidate algorithm. The PPVs of PSA >50 μg/L were 0.10 (95% confidence interval [CI] 0.04-0.19) for bone metastases and 0.14 (95% CI 0.07-0.24) for nonbone metastases, regardless of receipt of antiresorptive therapy or presence of bone scintigraphy. The PPVs for any metastases were 0.16 (95% CI 0.06-0.32) for PSA >50 μg/L and 0.28 (95% CI 0.14-0.47) for PSA >50 μg/L with bone scintigraphy. Adding antiresorptive treatment to the algorithm did not improve PPV. All negative predictive values approached 1.00.

Conclusion: Algorithms based on elevated PSA, antiresorptive therapy, or bone scintigraphy are not suitable for supplementing diagnostic codes to identify additional cases of distant metastases among men with prostate cancer. However, it is possible that in this setting, medical chart review is not a gold standard to identify metastases.

No MeSH data available.


Related in: MedlinePlus

Sampling of 212 patients with prostate cancer treated at Aarhus University Hospital, Denmark, 2005–2010.Abbreviations: ART, antiresorptive therapy; ICD, International Classification of Diseases; PSA, prostate-specific antigen; TNM, tumor, node, metastasis.
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f1-clep-7-259: Sampling of 212 patients with prostate cancer treated at Aarhus University Hospital, Denmark, 2005–2010.Abbreviations: ART, antiresorptive therapy; ICD, International Classification of Diseases; PSA, prostate-specific antigen; TNM, tumor, node, metastasis.

Mentions: We tested three candidate algorithms for bone metastases: 1) high PSA level (>50 μg/L) combined with bone scintigraphy, 2) high PSA level combined with antiresorptive therapy, and 3) low PSA level (≤50 μg/L) combined with either antiresorptive therapy or bone scintigraphy. The algorithm for nonbone metastases was defined as a high PSA level in the absence of antiresorptive therapy or bone scintigraphy (Figure 1). The index date was the date of fulfillment of the last component of a given algorithm. Absence of distant metastases was defined whenever all observed PSA measurements were ≤50 μg/L in the absence of a record of antiresorptive therapy or bone scintigraphy. For these patients, the index date was the date of the first PSA measurement ≤50 μg/L. All components of the algorithms had to be recorded on or after the diagnosis of prostate cancer. Table S1 lists the codes used in the algorithms.


Validation of algorithms to detect distant metastases in men with prostate cancer using routine registry data in Denmark.

Ehrenstein V, Hernandez RK, Maegbaek ML, Kahlert J, Nguyen-Nielsen M, Nørgaard M, Liede A - Clin Epidemiol (2015)

Sampling of 212 patients with prostate cancer treated at Aarhus University Hospital, Denmark, 2005–2010.Abbreviations: ART, antiresorptive therapy; ICD, International Classification of Diseases; PSA, prostate-specific antigen; TNM, tumor, node, metastasis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401359&req=5

f1-clep-7-259: Sampling of 212 patients with prostate cancer treated at Aarhus University Hospital, Denmark, 2005–2010.Abbreviations: ART, antiresorptive therapy; ICD, International Classification of Diseases; PSA, prostate-specific antigen; TNM, tumor, node, metastasis.
Mentions: We tested three candidate algorithms for bone metastases: 1) high PSA level (>50 μg/L) combined with bone scintigraphy, 2) high PSA level combined with antiresorptive therapy, and 3) low PSA level (≤50 μg/L) combined with either antiresorptive therapy or bone scintigraphy. The algorithm for nonbone metastases was defined as a high PSA level in the absence of antiresorptive therapy or bone scintigraphy (Figure 1). The index date was the date of fulfillment of the last component of a given algorithm. Absence of distant metastases was defined whenever all observed PSA measurements were ≤50 μg/L in the absence of a record of antiresorptive therapy or bone scintigraphy. For these patients, the index date was the date of the first PSA measurement ≤50 μg/L. All components of the algorithms had to be recorded on or after the diagnosis of prostate cancer. Table S1 lists the codes used in the algorithms.

Bottom Line: Among patients with prostate cancer, diagnostic codes for bone metastases in the Danish National Registry of Patients have a sensitivity of 44%.Adding antiresorptive treatment to the algorithm did not improve PPV.All negative predictive values approached 1.00.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Objective: Among patients with prostate cancer, diagnostic codes for bone metastases in the Danish National Registry of Patients have a sensitivity of 44%. In an attempt to improve the sensitivity of registry-based identification of metastases from prostate cancer, we tested a series of algorithms, combining elevated prostate-specific antigen (PSA) levels, use of antiresorptive therapy, and performed bone scintigraphy.

Patients and methods: We randomly selected 212 men diagnosed with prostate cancer in 2005-2010 in the Central Denmark Region with prespecified PSA values, antiresorptive therapy, and bone scintigraphy who did not have a registry-based diagnostic code indicating presence of distant metastases. We defined three candidate algorithms for bone metastases: 1) PSA >50 μg/L and bone scintigraphy, 2) PSA >50 μg/L and antiresorptive therapy, and 3) PSA ≤50 μg/L with antiresorptive therapy or bone scintigraphy. An algorithm for distant metastasis site other than bone was defined as PSA >50 μg/L alone. Medical chart review was used as the reference standard to establish the presence or absence of metastases. Validity was expressed as a positive predictive value (PPV) or a negative predictive value, based on whether the algorithms correctly classified metastases compared with the reference standard.

Results: We identified 113 men with evidence of metastases according to the candidate algorithms, and 99 men without evidence of metastases according to the candidate algorithm. The PPVs of PSA >50 μg/L were 0.10 (95% confidence interval [CI] 0.04-0.19) for bone metastases and 0.14 (95% CI 0.07-0.24) for nonbone metastases, regardless of receipt of antiresorptive therapy or presence of bone scintigraphy. The PPVs for any metastases were 0.16 (95% CI 0.06-0.32) for PSA >50 μg/L and 0.28 (95% CI 0.14-0.47) for PSA >50 μg/L with bone scintigraphy. Adding antiresorptive treatment to the algorithm did not improve PPV. All negative predictive values approached 1.00.

Conclusion: Algorithms based on elevated PSA, antiresorptive therapy, or bone scintigraphy are not suitable for supplementing diagnostic codes to identify additional cases of distant metastases among men with prostate cancer. However, it is possible that in this setting, medical chart review is not a gold standard to identify metastases.

No MeSH data available.


Related in: MedlinePlus