A nomogram predicting prostate cancer-specific mortality after radical prostatectomy.
OBJECTIVE
We describe a model capable of predicting prostate cancer (PCa)-specific mortality up to 20 years after a radical prostatectomy (RP), which can adjust the predictions according to disease-free interval.


METHODS
752 patients were treated with RP for organ-confined PCa. Cox regression modeled the probability of PCa-specific mortality. The significance of the predictors was confirmed in competing risks analyses, which account for other-cause mortality.


RESULTS
The mean follow-up was 11.4 years. The 5-, 10-, 15- and 20-year actuarial rates of PCa-specific survival were 99.0, 95.5, 90.9 and 85.7%, respectively. RP Gleason sum (p < 0.001), pT stage (p = 0.007), adjuvant radiotherapy (p = 0.03) and age at RP (p = 0.004) represented independent predictors of PCa-specific mortality in the Cox regression model as well as in competing risks regression. Those variables, along with lymph node dissection status (p = 0.4), constituted the nomogram predictors. After 200 bootstrap resamples, the nomogram achieved 82.6, 83.8, 75.0 and 76.3% accuracy in predicting PCa-specific mortality at 5, 10, 15 and 20 years post-RP, respectively.


CONCLUSIONS
At 20 years, roughly 20% of men treated with RP may succumb to PCa. The current nomogram helps to identify these individuals. Their follow-up or secondary therapies may be adjusted according to nomogram predictions.
Porter
Christopher R
CR
Department of Urology, Virginia Mason Medical Center, Seattle, Wash, USA.
Suardi
Nazareno
N
Capitanio
Umberto
U
Hutterer
Georg C
GC
Kodama
Koichi
K
Gibbons
Robert P
RP
Correa
Roy
R
Perrotte
Paul
P
Montorsi
Francesco
F
Karakiewicz
Pierre I
PI
D000328:Adult; D000368:Aged; D000465:Algorithms; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D012008:Recurrence; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen