title: Updating risk prediction tools: a case study in prostate cancer.
abstract: Online risk prediction tools for common cancers are now easily accessible and widely used by patients and doctors for informed decision-making concerning screening and diagnosis. A practical problem is as cancer research moves forward and new biomarkers and risk factors are discovered, there is a need to update the risk algorithms to include them. Typically, the new markers and risk factors cannot be retrospectively measured on the same study participants used to develop the original prediction tool, necessitating the merging of a separate study of different participants, which may be much smaller in sample size and of a different design. Validation of the updated tool on a third independent data set is warranted before the updated tool can go online. This article reports on the application of Bayes rule for updating risk prediction tools to include a set of biomarkers measured in an external study to the original study used to develop the risk prediction tool. The procedure is illustrated in the context of updating the online Prostate Cancer Prevention Trial Risk Calculator to incorporate the new markers %freePSA and [-2]proPSA measured on an external case-control study performed in Texas, U.S.. Recent state-of-the art methods in validation of risk prediction tools and evaluation of the improvement of updated to original tools are implemented using an external validation set provided by the U.S. Early Detection Research Network.
authors.affiliation: Department of Mathematics, Technische Universitaet Muenchen, Unit M4, Boltzmannstr 3, 85748 Garching b. Munich, Germany. ankerst@ma.tum.de
authors.forename: Donna P
authors.initials: DP
authors.lastname: Ankerst
authors.forename: Tim
authors.initials: T
authors.lastname: Koniarski
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Liang
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Leach
authors.forename: Ziding
authors.initials: Z
authors.lastname: Feng
authors.forename: Martin G
authors.initials: MG
authors.lastname: Sanda
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Chan
authors.forename: Jacob
authors.initials: J
authors.lastname: Kagan
authors.forename: Lori
authors.initials: L
authors.lastname: Sokoll
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: Ian M
authors.initials: IM
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D014408:Biomarkers, Tumor / Q000378:metabolism; D002986:Clinical Trials as Topic; D016002:Discriminant Analysis; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008490:Medical Informatics / Q000379:methods*; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor
references.citation: CA Cancer J Clin. 2010 Mar-Apr;60(2):70-98
references.pmid: 20200110
references.citation: J Natl Cancer Inst. 1989 Dec 20;81(24):1879-86
references.pmid: 2593165
references.citation: Urology. 2006 Dec;68(6):1152-5
references.pmid: 17169636
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 May;19(5):1193-200
references.pmid: 20447916
references.citation: JAMA. 2005 Jul 6;294(1):66-70
references.pmid: 15998892
references.citation: Med Decis Making. 2005 Mar-Apr;25(2):168-77
references.pmid: 15800301
references.citation: Am J Epidemiol. 1982 Jan;115(1):92-106
references.pmid: 7055134
references.citation: N Engl J Med. 2003 Jul 17;349(3):215-24
references.pmid: 12824459
references.citation: Biostatistics. 2009 Jan;10(1):172-86
references.pmid: 18714084
references.citation: Epidemiology. 2010 Jan;21(1):128-38
references.pmid: 20010215
references.citation: J Natl Cancer Inst. 2007 Dec 5;99(23):1782-92
references.pmid: 18042936
references.citation: Biostatistics. 2011 Jan;12(1):87-101
references.pmid: 20639522
references.citation: Circulation. 2004 Jul 13;110(2):227-39
references.pmid: 15249516
references.citation: J Clin Epidemiol. 2010 Jul;63(7):721-7
references.pmid: 20338724
references.citation: J Natl Cancer Inst. 2006 Apr 19;98(8):529-34
references.pmid: 16622122
references.citation: Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
references.pmid: 17569110
references.citation: Med Decis Making. 2006 Nov-Dec;26(6):565-74
references.pmid: 17099194
references.citation: N Engl J Med. 2004 May 27;350(22):2239-46
references.pmid: 15163773
references.citation: J Urol. 2011 Jan;185(1):104-10
references.pmid: 21074193
references.citation: J Urol. 2009 Dec;182(6):2653-8
references.pmid: 19836788
references.citation: Stat Methods Med Res. 2007 Jun;16(3):219-42
references.pmid: 17621469
references.citation: J Urol. 2010 Feb;183(2):529-33
references.pmid: 20006887
references.citation: Stat Med. 2008 Jan 30;27(2):199-206
references.pmid: 17729377
references.citation: J Natl Cancer Inst. 2001 Jul 18;93(14):1054-61
references.pmid: 11459866
references.citation: J Urol. 2008 Oct;180(4):1303-8; discussion 1308
references.pmid: 18707724
references.citation: Biometrics. 1988 Sep;44(3):837-45
references.pmid: 3203132
references.citation: BJU Int. 2009 Mar;103(5):609-14
references.pmid: 19007374