title: Head-to-head comparison of the three most commonly used preoperative models for prediction of biochemical recurrence after radical prostatectomy.
abstract: BACKGROUND
  Several models can predict the rate of biochemical recurrence (BCR) after radical prostatectomy (RP).
  
  
  OBJECTIVE
  We tested the three most commonly used models-the D'Amico risk stratification scheme, the Cancer of the Prostate Risk Assessment (CAPRA) score, and the Stephenson nomogram-in a European cohort of RP patients.
  
  
  METHODS
  We relied on preoperative characteristics and prostate-specific antigen follow-up data of 1976 patients, as required by the three tested models. All patients were treated with an open RP between 1992 and 2006.
  
  
  METHODS
  Analyses included tests of accuracy (Harrell's concordance index) and calibration between predicted and observed BCR rates at 3 yr and 5 yr after RP. Additionally, we relied on decision curve analyses to compare the three models directly in a head-to-head fashion.
  
  
  CONCLUSIONS
  The median follow-up of censored patients was 32 mo. BCR-free rates at 3 yr and 5 yr after RP were 80.2% and 72.6%, respectively. The concordance index for 3-yr BCR predictions was 70.4%, 74.3%, and 75.2% for the D'Amico, CAPRA, and Stephenson models, respectively, versus 67.4%, 72.9%, and 73.5% for 5-yr BCR predictions. Calibration results supported the use of either the CAPRA or Stephenson models. Decision curve analyses indicated a small benefit for the CAPRA score relative to the Stephenson nomogram. Our findings apply to German patients treated with RP at a high-volume tertiary care centre. Consequently, the rank order reported in this paper may not be the same in North American or other European cohorts.
  
  
  CONCLUSIONS
  Different methods yield different results, and it may be difficult to reconcile concordance index, calibration, and decision curve analysis findings. Our data suggest that the CAPRA score outperforms the other models when decision curve analysis and calibration were used as benchmarks. Conversely, the Stephenson nomogram outperformed the other models when concordance index was used as a metric.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Lars
authors.initials: L
authors.lastname: Budäus
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049451:Nomograms; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012044:Regression Analysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen