title: A Bayesian hierarchical model for prediction of latent health states from multiple data sources with application to active surveillance of prostate cancer.
abstract: In this article, we present a Bayesian hierarchical model for predicting a latent health state from longitudinal clinical measurements. Model development is motivated by the need to integrate multiple sources of data to improve clinical decisions about whether to remove or irradiate a patient's prostate cancer. Existing modeling approaches are extended to accommodate measurement error in cancer state determinations based on biopsied tissue, clinical measurements possibly not missing at random, and informative partial observation of the true state. The proposed model enables estimation of whether an individual's underlying prostate cancer is aggressive, requiring surgery and/or radiation, or indolent, permitting continued surveillance. These individualized predictions can then be communicated to clinicians and patients to inform decision-making. We demonstrate the model with data from a cohort of low-risk prostate cancer patients at Johns Hopkins University and assess predictive accuracy among a subset for whom true cancer state is observed. Simulation studies confirm model performance and explore the impact of adjusting for informative missingness on true state predictions. R code is provided in an online supplement and at http://github.com/rycoley/prediction-prostate-surveillance.
authors.affiliation: Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland 21205, U.S.A.
authors.forename: Rebecca Yates
authors.initials: RY
authors.lastname: Coley
authors.affiliation: Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland 21205, U.S.A.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Fisher
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, U.S.A.
authors.forename: Mufaddal
authors.initials: M
authors.lastname: Mamawala
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, U.S.A.|Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, U.S.A.
authors.forename: Herbert Ballentine
authors.initials: HB
authors.lastname: Carter
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, U.S.A.|Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, U.S.A.|Department of Pharmacology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Pienta
authors.affiliation: Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland 21205, U.S.A.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zeger
mesh_terms: D001499:Bayes Theorem; D001706:Biopsy; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D011471:Prostatic Neoplasms
keywords: Latent class analysis; Missing data; Precision medicine; Prostate cancer prognosis; Risk classification