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: External validation of recurrence and PCa mortality
2019
textabstractObjectives
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 screeningdetected 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 SPCa 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 SPCa. 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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