A Bayesian Hierarchical Model for Prediction of Latent Health States from Multiple Data Sources with Application to Active Surveillance of Prostate Cancer

TL;DR

This paper introduces a Bayesian hierarchical model that integrates multiple data sources to accurately predict latent prostate cancer states, aiding personalized treatment decisions in active surveillance.

Contribution

The novel model accounts for measurement error, missing data, and partial observations, improving prediction of cancer aggressiveness from diverse clinical data sources.

Findings

Model accurately predicts cancer state in real patient data.

Simulation confirms robustness and benefits of adjusting for missing data.

Enhanced decision-making support for prostate cancer management.

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 and simulated data available at https://github.com/rycoley/prediction-prostate-surveillance.