Abstract
ObjectivesAlthough the incidence of prostate cancer (PCa) is rapidly increasing in Korea, there are few suitable prediction models for disease recurrence after radical prostatectomy (RP). We established pre- and post-operative nomograms estimating biochemical recurrence (BCR)-free probability after RP in Korean men with clinically localized PCa.Patients and MethodsOur sampling frame included 3,034 consecutive men with clinically localized PCa who underwent RP at our tertiary centers from June 2004 through July 2011. After inappropriate data exclusion, we evaluated 2,867 patients for the development of nomograms. The Cox proportional hazards regression model was used to develop pre- and post-operative nomograms that predict BCR-free probability. Finally, we resampled from our study cohort 200 times to determine the accuracy of our nomograms on internal validation, which were designated with concordance index (c-index) and further represented by calibration plots.ResultsOver a median of 47 months of follow-up, the estimated BCR-free rate was 87.8% (1 year), 83.8% (2 year), and 72.5% (5 year). In the pre-operative model, Prostate-Specific Antigen (PSA), the proportion of positive biopsy cores, clinical T3a and biopsy Gleason score (GS) were independent predictive factors for BCR, while all relevant predictive factors (PSA, extra-prostatic extension, seminal vesicle invasion, lymph node metastasis, surgical margin, and pathologic GS) were associated with BCR in the post-operative model. The c-index representing predictive accuracy was 0.792 (pre-) and 0.821 (post-operative), showing good fit in the calibration plots.ConclusionsIn summary, we developed pre- and post-operative nomograms predicting BCR-free probability after RP in a large Korean cohort with clinically localized PCa. These nomograms will be provided as the mobile application-based SNUH Prostate Cancer Calculator. Our nomograms can determine patients at high risk of disease recurrence after RP who will benefit from adjuvant therapy.
Highlights
Prostate cancer (PCa) is the most common malignancy among men worldwide, and is a primary leading cause of cancerassociated death in Western men [1]
Our nomograms can determine patients at high risk of disease recurrence after radical prostatectomy (RP) who will benefit from adjuvant therapy
Patient Population We reviewed the medical records of 3,034 consecutive patients diagnosed with clinical stage T1c–T3a PCa who underwent RP at SNUH and Seoul National University Bundang Hospital (SNUBH) from June 2004 through July 2011
Summary
Prostate cancer (PCa) is the most common malignancy among men worldwide, and is a primary leading cause of cancerassociated death in Western men [1]. After radical prostatectomy (RP), the current gold standard of treatment for clinically localized PCa [2], about 30% of patients who underwent RP developed biochemical recurrence (BCR). These are patients who should receive adjuvant therapy with careful surveillance [3,4]. Preoperative and post-operative prediction of BCR is important for patient counseling as well as informed decision-making of proper adjuvant therapeutic strategy [5]. Several validated methods, including risk groupings, probability tables, artificial neural network and nomograms have been developed to predict BCR accurately despite the heterogeneity of PCa [8]
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