Radiation Therapy Treatment Decision Making for Prostate Cancer Patients Based on PSA Dynamics
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1 adiaion Theapy Teamen Decision Making fo Posae Cance Paiens Based on PSA Dynamics Maiel S. Laiei Main L. Pueman Sco Tyldesley Seen Sheche
2 Ouline Backgound Infomaion Model Descipion Nex Seps Moiaion Tadeoffs Cuen poocol Ou goal The model
3 Moiaion High isk posae cance paiens migh be offeed neoadjuan homone heapy o induce posae cance cell deah and umo egession pio o hei adioheapy eamen Paiens ae monioed peiodically Maximal umo egession pobably occus when PSA eaches is nadi leel M. S Gleae S. La Bianca S. L. Goldebeg 000 No known when such leel will be achieed
4 Tadeoffs Toleance esponsieness Why decide o ea? - Aoid pogession - isk of cells becoming esisan - Toxiciy of homone heapy Why wai? - Maximum educion of umo size unde homone heapy - Moe infomaion
5 Cuen Poocol High-inemediae o high isk paien? Offe neoadjuan homone heapy pio o adiaion heapy Sa adiaion heapy if: 8 monhs of homone heapy hae been eceied o Nadi PSA 0.05 is eached afe 4 monhs o PSA leels sa o ise o PSA < ng/ml is no achieed afe 4 monhs
6 Ou Goal Impoe modeling of PSA kineics and esimaion of fuue PSA kineics Poide a fomal decision making ool o deemine when a paien should begin adiaion heapy eamen
7 Modeling PSA ln PSA α d ln PSA 0 d ~ N0 V PSA S s s imee Expeced minimum nadi PSA nadi Time
8 Timeline Obsee PSA Updae cue paamees Don Sa Sa T? eceie eamen Obsee PSA Updae cue paamees ζ P ime of nadi ζ Sae Updaing Kalman Fileing
9 Sa T Don Sa T Decision Tee Pob nadi is wihin ζ days Sa T New PSA Don Sa T
10 PSA 0 0. PSA s ime Time fom NAH sa days minimum
11 Model Model Discee ime finie hoizon MDP Acion: Sae: ; Sa adiaion heapy Don sa adiaion heapy Paamee means PSA : Obseed PSA Paamee coaiances α 0 ~ ln V N PSA Y α N α α ; ~
12 Model Maximize Pobabiliy of Teaing wihin ζ of he Nadi Sa T P nadi ζ ; max P Don Sa T
13 Sa T - Disibuion of Time of Nadi nadi -/ ~ N ; whee 3 P nadi ζ ; max P 3 Disibuion of ime of nadi 60% elaie fequency 50% 40% 30% 0% 0% 0% Time of nadi >70
14 ; max nadi P P ζ Sa T Sa T - Disibuion of Time of Nadi Disibuion of Time of Nadi du e F u nadi 3 4 π du e u ζ ζ ζ π ζ P nadi Hinkley969 nadi -/ whee As P >0 N 3 3 ; ~ α
15 ; max nadi P P ζ Don Don Sa T Sa T Sae Updaing Sae Updaing Y P Y P V N Y ~ α F Q F F Y Q F ' ' ] [ Sae equaions: Updaing equaions: α F V Q Gien Y
16 Model Model Maximize Pobabiliy of Teaing Maximize Pobabiliy of Teaing wihin wihin ζ of he Nadi of he Nadi ; max nadi P P ζ α F V Q ' ~ Q F N Y du e u ζ ζ ζ π Sa T [ ] Y Y dp F Q F F Y Q F ' ' Don Sa T
17 Nex Seps Appoximae soluion - Bayesian inegaions - Simulaion Sucue of policies Conside ohe possible objecies: - Minimize cos - Minimize disance of nadi obseed o nadi expeced - Maximize suial Addiional quesions: - When o ake nex eading? - When o change homone eamen? - Is 8 monhs a good endpoin? Model Validaion Design clinical sudy
18 Thank you Maiel Laiei
When to Treat Prostate Cancer Patients Based on their PSA Dynamics
When o Tea Posae Cance Paens Based on he PSA Dynamcs CLARA day on opeaons eseach n cance eamen & opeaons managemen Novembe 7 00 Mael S. Lave PhD Man L. Pueman PhD Sco Tyldesley M.D. Wllam J. Mos M.D CIHR
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