title: Do prostate cancer nomograms give accurate information when applied to European patients?
abstract: OBJECTIVE
  The aim of this study was to validate and compare the performance of preoperative risk assessment tools in a population of men treated with radical prostatectomy at a single European institution.
  
  
  METHODS
  Patients were identified from databases of radical prostatectomy between 1996 and 2011 from a single UK centre. Information was obtained on demographics, prostate-specific antigen, staging, biopsy and specimen histopathology, and follow-up. Data were inputted into the Memorial Sloan-Kettering Cancer Center (MSKCC), Partin 1997 and Makarov/Partin 2007 nomograms, and the University of California San Francisco-Cancer of the Prostate Risk Assessment tool (UCSF-CAPRA). The risks of extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph-node involvement (LNI) were calculated and compared with known outcomes. Nomogram performance was measured using Hosmer-Lemeshow (HL) goodness-of-fit tests, calculating concordance indices (c-indices) and calibration curves.
  
  
  RESULTS
  Data were obtained for 541 patients. Prediction of ECE was relatively poor using all nomograms, with the Makarov/Partin 2007 the most accurate at prediction over the range of risk stratification (HL 9.9, c-index 0.62). Predictions of SVI and LNI were better than for ECE, with the MSKCC nomogram performing best for SVI (HL 10.9, c-index 0.73) and all nomograms performing well for LNI prediction (c-indices 0.8 to 0.815). CAPRA predicted best for SVI (OR 1.49, 95% confidence interval 1.27-1.74).
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first head-to-head comparison of the accuracy of these commonly used risk calculators in a North European population. Caution should be used when counselling patients using nomograms. Although nomograms may be used as a guide, patients should be warned that they often have not been validated on different European populations and may give misleading information regarding a patient's specific risks.
authors.affiliation: Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust , Leeds , UK.
authors.forename: Rafal
authors.initials: R
authors.lastname: Turo
authors.forename: James A
authors.initials: JA
authors.lastname: Forster
authors.forename: Robert M
authors.initials: RM
authors.lastname: West
authors.forename: Stephen
authors.initials: S
authors.lastname: Prescott
authors.forename: Alan B
authors.initials: AB
authors.lastname: Paul
authors.forename: William R
authors.initials: WR
authors.lastname: Cross
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D005060:Europe; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049451:Nomograms; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D018570:Risk Assessment; D012669:Seminal Vesicles / Q000473:pathology*; D006113:United Kingdom
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: cancer; nomogram; prostate.