Contemporary approach to predict early biochemical recurrence after radical prostatectomy: update of the Walz nomogram.

Overview

BACKGROUND: Early biochemical recurrence (eBCR) after radical prostatectomy (RP) heralds poor oncological outcomes and may be prevented with adjuvant radiation (aRT). METHODS: We developed a contemporary eBCR nomogram in 13 797 RP patients from Hamburg (2005-2016) and externally validated it in 5952 RP patients from Vienna. Receiver operating characteristics-derived area under the curve (AUC), Heagerty's C-index, and decision curve analysis (DCA) were used to quantify model accuracy and to compare the current tool with the Walz nomogram, the online Memorial Sloan Kettering Cancer Center (MSKCC) nomogram and the post-surgical Cancer of the Prostate Risk Assesment (CAPRA-S). RESULTS: The eBCR nomogram relies on independent BCR predictors at 12 and 24 months after RP: preoperative PSA, pathological Gleason Score, tumor stage, lymph node, and surgical margin status. It achieved 81% accuracy at both time points in external validation. Additionally, the current nomogram yielded best calibration, optimal DCA results, and highest rates of avoided aRT in cutoff analyses, compared to the Walz nomogram, the MSKCC nomogram, and the CAPRA-S score. CONCLUSIONS: The updated eBCR nomogram is easily applicable, highly accurate, and may allow avoiding immediate aRT in a large proportion of patients with few concomitant missed eBCR instances. It compares favorably to similar tools.