Predicting biochemical recurrence and prostate cancer‐specific mortality after radical prostatectomy: comparison of six prediction models in a cohort of patients with screening‐ and clinically detected prostate cancer
Objectives To perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer (PCa)‐specific mortality (PCSM) in a screening setting, i.e. patients with screening‐detected PCa (S‐PCa) and in those with clinically detect...
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| Published in | BJU international Vol. 124; no. 4; pp. 635 - 642 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Wiley Subscription Services, Inc
01.10.2019
John Wiley and Sons Inc |
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| Online Access | Get full text |
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| Abstract | Objectives
To perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer (PCa)‐specific mortality (PCSM) in a screening setting, i.e. patients with screening‐detected PCa (S‐PCa) and in those with clinically detected PCa (C‐PCa).
Subjects and Methods
We retrospectively evaluated 795 men with S‐PCa, from the European Randomized Study of Screening for Prostate Cancer, Rotterdam, and 1123 men with C‐PCa initially treated with RP. The discriminative ability of the models was assessed according to the area under the curve (AUC) of the receiver‐operating characteristic, and calibration was assessed graphically using calibration plots.
Results
The median (interquartile range [IQR]) follow‐up for the S‐PCa group was 10.4 (6.8–14.3) years and for the C‐PCa group it was 8.8 (4.8–12.9) years. A total of 123 men with S‐PCa (15%) and 389 men with C‐PCa (35%) experienced BCR. Of the men with S‐PCa and BCR, 24 (20%) died from PCa and 29 (23%) died from other causes. Of the men with C‐PCa and BCR, 68 (17%) died from PCa and 105 (27%) died from other causes. The discrimination of the models predicting BCR or PCSM was higher for men with S‐PCa (AUC: BCR 0.77–0.84, PCSM 0.60–0.77) than for the men with C‐PCa (AUC: BCR 0.75–0.79, PCSM 0.51–0.68) as a result of the similar patient characteristics of the men with S‐PCa in the present study and those of the cohorts used to develop these models. The risk of BCR was typically overestimated, while the risk of PCSM was typically underestimated.
Conclusion
Prediction models for BCR showed good discrimination and reasonable calibration for both men with S‐PCa and men with C‐PCa, and even better discrimination for men with S‐PCa. For PCSM, the evaluated models are not applicable in both settings of this Dutch cohort as a result of substantial miscalibration. This warrants caution when using these models to communicate future risks in other clinical settings. |
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| AbstractList | To perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer (PCa)-specific mortality (PCSM) in a screening setting, i.e. patients with screening-detected PCa (S-PCa) and in those with clinically detected PCa (C-PCa).
We retrospectively evaluated 795 men with S-PCa, from the European Randomized Study of Screening for Prostate Cancer, Rotterdam, and 1123 men with C-PCa initially treated with RP. The discriminative ability of the models was assessed according to the area under the curve (AUC) of the receiver-operating characteristic, and calibration was assessed graphically using calibration plots.
The median (interquartile range [IQR]) follow-up for the S-PCa group was 10.4 (6.8-14.3) years and for the C-PCa group it was 8.8 (4.8-12.9) years. A total of 123 men with S-PCa (15%) and 389 men with C-PCa (35%) experienced BCR. Of the men with S-PCa and BCR, 24 (20%) died from PCa and 29 (23%) died from other causes. Of the men with C-PCa and BCR, 68 (17%) died from PCa and 105 (27%) died from other causes. The discrimination of the models predicting BCR or PCSM was higher for men with S-PCa (AUC: BCR 0.77-0.84, PCSM 0.60-0.77) than for the men with C-PCa (AUC: BCR 0.75-0.79, PCSM 0.51-0.68) as a result of the similar patient characteristics of the men with S-PCa in the present study and those of the cohorts used to develop these models. The risk of BCR was typically overestimated, while the risk of PCSM was typically underestimated.
Prediction models for BCR showed good discrimination and reasonable calibration for both men with S-PCa and men with C-PCa, and even better discrimination for men with S-PCa. For PCSM, the evaluated models are not applicable in both settings of this Dutch cohort as a result of substantial miscalibration. This warrants caution when using these models to communicate future risks in other clinical settings. ObjectivesTo perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer (PCa)‐specific mortality (PCSM) in a screening setting, i.e. patients with screening‐detected PCa (S‐PCa) and in those with clinically detected PCa (C‐PCa).Subjects and MethodsWe retrospectively evaluated 795 men with S‐PCa, from the European Randomized Study of Screening for Prostate Cancer, Rotterdam, and 1123 men with C‐PCa initially treated with RP. The discriminative ability of the models was assessed according to the area under the curve (AUC) of the receiver‐operating characteristic, and calibration was assessed graphically using calibration plots.ResultsThe median (interquartile range [IQR]) follow‐up for the S‐PCa group was 10.4 (6.8–14.3) years and for the C‐PCa group it was 8.8 (4.8–12.9) years. A total of 123 men with S‐PCa (15%) and 389 men with C‐PCa (35%) experienced BCR. Of the men with S‐PCa and BCR, 24 (20%) died from PCa and 29 (23%) died from other causes. Of the men with C‐PCa and BCR, 68 (17%) died from PCa and 105 (27%) died from other causes. The discrimination of the models predicting BCR or PCSM was higher for men with S‐PCa (AUC: BCR 0.77–0.84, PCSM 0.60–0.77) than for the men with C‐PCa (AUC: BCR 0.75–0.79, PCSM 0.51–0.68) as a result of the similar patient characteristics of the men with S‐PCa in the present study and those of the cohorts used to develop these models. The risk of BCR was typically overestimated, while the risk of PCSM was typically underestimated.ConclusionPrediction models for BCR showed good discrimination and reasonable calibration for both men with S‐PCa and men with C‐PCa, and even better discrimination for men with S‐PCa. For PCSM, the evaluated models are not applicable in both settings of this Dutch cohort as a result of substantial miscalibration. This warrants caution when using these models to communicate future risks in other clinical settings. To perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer (PCa)-specific mortality (PCSM) in a screening setting, i.e. patients with screening-detected PCa (S-PCa) and in those with clinically detected PCa (C-PCa).OBJECTIVESTo perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer (PCa)-specific mortality (PCSM) in a screening setting, i.e. patients with screening-detected PCa (S-PCa) and in those with clinically detected PCa (C-PCa).We retrospectively evaluated 795 men with S-PCa, from the European Randomized Study of Screening for Prostate Cancer, Rotterdam, and 1123 men with C-PCa initially treated with RP. The discriminative ability of the models was assessed according to the area under the curve (AUC) of the receiver-operating characteristic, and calibration was assessed graphically using calibration plots.SUBJECTS AND METHODSWe retrospectively evaluated 795 men with S-PCa, from the European Randomized Study of Screening for Prostate Cancer, Rotterdam, and 1123 men with C-PCa initially treated with RP. The discriminative ability of the models was assessed according to the area under the curve (AUC) of the receiver-operating characteristic, and calibration was assessed graphically using calibration plots.The median (interquartile range [IQR]) follow-up for the S-PCa group was 10.4 (6.8-14.3) years and for the C-PCa group it was 8.8 (4.8-12.9) years. A total of 123 men with S-PCa (15%) and 389 men with C-PCa (35%) experienced BCR. Of the men with S-PCa and BCR, 24 (20%) died from PCa and 29 (23%) died from other causes. Of the men with C-PCa and BCR, 68 (17%) died from PCa and 105 (27%) died from other causes. The discrimination of the models predicting BCR or PCSM was higher for men with S-PCa (AUC: BCR 0.77-0.84, PCSM 0.60-0.77) than for the men with C-PCa (AUC: BCR 0.75-0.79, PCSM 0.51-0.68) as a result of the similar patient characteristics of the men with S-PCa in the present study and those of the cohorts used to develop these models. The risk of BCR was typically overestimated, while the risk of PCSM was typically underestimated.RESULTSThe median (interquartile range [IQR]) follow-up for the S-PCa group was 10.4 (6.8-14.3) years and for the C-PCa group it was 8.8 (4.8-12.9) years. A total of 123 men with S-PCa (15%) and 389 men with C-PCa (35%) experienced BCR. Of the men with S-PCa and BCR, 24 (20%) died from PCa and 29 (23%) died from other causes. Of the men with C-PCa and BCR, 68 (17%) died from PCa and 105 (27%) died from other causes. The discrimination of the models predicting BCR or PCSM was higher for men with S-PCa (AUC: BCR 0.77-0.84, PCSM 0.60-0.77) than for the men with C-PCa (AUC: BCR 0.75-0.79, PCSM 0.51-0.68) as a result of the similar patient characteristics of the men with S-PCa in the present study and those of the cohorts used to develop these models. The risk of BCR was typically overestimated, while the risk of PCSM was typically underestimated.Prediction models for BCR showed good discrimination and reasonable calibration for both men with S-PCa and men with C-PCa, and even better discrimination for men with S-PCa. For PCSM, the evaluated models are not applicable in both settings of this Dutch cohort as a result of substantial miscalibration. This warrants caution when using these models to communicate future risks in other clinical settings.CONCLUSIONPrediction models for BCR showed good discrimination and reasonable calibration for both men with S-PCa and men with C-PCa, and even better discrimination for men with S-PCa. For PCSM, the evaluated models are not applicable in both settings of this Dutch cohort as a result of substantial miscalibration. This warrants caution when using these models to communicate future risks in other clinical settings. Objectives To perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer (PCa)‐specific mortality (PCSM) in a screening setting, i.e. patients with screening‐detected PCa (S‐PCa) and in those with clinically detected PCa (C‐PCa). Subjects and Methods We retrospectively evaluated 795 men with S‐PCa, from the European Randomized Study of Screening for Prostate Cancer, Rotterdam, and 1123 men with C‐PCa initially treated with RP. The discriminative ability of the models was assessed according to the area under the curve (AUC) of the receiver‐operating characteristic, and calibration was assessed graphically using calibration plots. Results The median (interquartile range [IQR]) follow‐up for the S‐PCa group was 10.4 (6.8–14.3) years and for the C‐PCa group it was 8.8 (4.8–12.9) years. A total of 123 men with S‐PCa (15%) and 389 men with C‐PCa (35%) experienced BCR. Of the men with S‐PCa and BCR, 24 (20%) died from PCa and 29 (23%) died from other causes. Of the men with C‐PCa and BCR, 68 (17%) died from PCa and 105 (27%) died from other causes. The discrimination of the models predicting BCR or PCSM was higher for men with S‐PCa (AUC: BCR 0.77–0.84, PCSM 0.60–0.77) than for the men with C‐PCa (AUC: BCR 0.75–0.79, PCSM 0.51–0.68) as a result of the similar patient characteristics of the men with S‐PCa in the present study and those of the cohorts used to develop these models. The risk of BCR was typically overestimated, while the risk of PCSM was typically underestimated. Conclusion Prediction models for BCR showed good discrimination and reasonable calibration for both men with S‐PCa and men with C‐PCa, and even better discrimination for men with S‐PCa. For PCSM, the evaluated models are not applicable in both settings of this Dutch cohort as a result of substantial miscalibration. This warrants caution when using these models to communicate future risks in other clinical settings. |
| Author | Nieboer, Daan Kwast, Theo Verbeek, Jan F. M. Roobol, Monique J. Remmers, Sebastiaan |
| AuthorAffiliation | 2 Department of Public Health Erasmus University Medical Centre Rotterdam The Netherlands 4 Department of Pathology Toronto General Hospital Toronto ON Canada 1 Department of Urology Erasmus University Medical Centre Rotterdam The Netherlands 3 Department of Pathology Erasmus University Medical Centre Rotterdam The Netherlands |
| AuthorAffiliation_xml | – name: 3 Department of Pathology Erasmus University Medical Centre Rotterdam The Netherlands – name: 1 Department of Urology Erasmus University Medical Centre Rotterdam The Netherlands – name: 4 Department of Pathology Toronto General Hospital Toronto ON Canada – name: 2 Department of Public Health Erasmus University Medical Centre Rotterdam The Netherlands |
| Author_xml | – sequence: 1 givenname: Sebastiaan orcidid: 0000-0001-9530-6448 surname: Remmers fullname: Remmers, Sebastiaan email: s.remmers@erasmusmc.nl organization: Erasmus University Medical Centre – sequence: 2 givenname: Jan F. M. surname: Verbeek fullname: Verbeek, Jan F. M. organization: Erasmus University Medical Centre – sequence: 3 givenname: Daan surname: Nieboer fullname: Nieboer, Daan organization: Erasmus University Medical Centre – sequence: 4 givenname: Theo surname: Kwast fullname: Kwast, Theo organization: Toronto General Hospital – sequence: 5 givenname: Monique J. orcidid: 0000-0001-6967-1708 surname: Roobol fullname: Roobol, Monique J. organization: Erasmus University Medical Centre |
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To perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer... To perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer... ObjectivesTo perform a comparison and external validation of three models predicting biochemical recurrence (BCR) and three models predicting prostate cancer... |
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| SubjectTerms | Calibration Cancer surgery Clinical decision making Mortality nomograms PCSM Prediction models probability Prostate cancer ProstateCancer Prostatectomy prostatic neoplasms Urological Oncology Urological surgery |
| Title | Predicting biochemical recurrence and prostate cancer‐specific mortality after radical prostatectomy: comparison of six prediction models in a cohort of patients with screening‐ and clinically detected prostate cancer |
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