title: Nomogram Predicting Prostate Cancer-specific Mortality for Men with Biochemical Recurrence After Radical Prostatectomy.
abstract: BACKGROUND
  The natural history of prostate-specific antigen (PSA)-defined biochemical recurrence (BCR) of prostate cancer (PCa) after definitive local therapy is highly variable. Validated prediction models for PCa-specific mortality (PCSM) in this population are needed for treatment decision-making and clinical trial design.
  
  
  OBJECTIVE
  To develop and validate a nomogram to predict the probability of PCSM from the time of BCR among men with rising PSA levels after radical prostatectomy.
  
  
  METHODS
  Between 1987 and 2011, 2254 men treated by radical prostatectomy at one of five high-volume hospitals experienced BCR, defined as three successive PSA rises (final value >0.2 ng/ml), single PSA >0.4 ng/ml, or use of secondary therapy administered for detectable PSA >0.1 ng/ml. Clinical information and follow-up data were modeled using competing-risk regression analysis to predict PCSM from the time of BCR.
  
  
  METHODS
  Radical prostatectomy for localized prostate cancer and subsequent PCa BCR.
  
  
  METHODS
  PCSM.
  
  
  CONCLUSIONS
  The 10-yr PCSM and mortality from competing causes was 19% (95% confidence interval [CI] 16-21%) and 17% (95% CI 14-19%), respectively. A nomogram predicting PCSM for all patients had an internally validated concordance index of 0.774. Inclusion of PSA doubling time (PSADT) in a nomogram based on standard parameters modestly improved predictive accuracy (concordance index 0.763 vs 0.754). Significant parameters in the models were preoperative PSA, pathological Gleason score, extraprostatic extension, seminal vesicle invasion, time to PCa BCR, PSA level at PCa BCR, and PSADT (all p<0.05).
  
  
  CONCLUSIONS
  We constructed and validated a nomogram to predict the risk of PCSM at 10 yr among men with PCa BCR after radical prostatectomy. The nomogram may be used for patient counseling and the design of clinical trials for PCa.
  
  
  RESULTS
  For men with biochemical recurrence of prostate cancer after radical prostatectomy, we have developed a model to predict the long-term risk of death from prostate cancer.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Brockman
authors.affiliation: Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Alanee
authors.affiliation: Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vickers
authors.affiliation: Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Wood
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.affiliation: Department of Urology, Columbia University, New York, NY, USA.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Bianco
authors.affiliation: Division of Urology, Department of Surgery, Princess Johara Alibrahim Center for Cancer Research, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Danny M
authors.initials: DM
authors.lastname: Rabah
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.affiliation: Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Tianming
authors.initials: T
authors.lastname: Gao
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: stephena2@ccf.org.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D049451:Nomograms; D011379:Prognosis; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen
keywords: Prostatectomy; Prostatic neoplasms; Statistical models