TY - JOUR

T1 - The CPC Risk Calculator

T2 - A New App to Predict Prostate-specific Antigen Recurrence During Follow-up After Radical Prostatectomy

AU - Røder, Martin Andreas

AU - Berg, Kasper Drimer

AU - Loft, Mathias Dyrberg

AU - Thomsen, Frederik Birkebæk

AU - Ferrari, Michelle

AU - Kurbegovic, Sorel

AU - Rytgaard, Helene Charlotte

AU - Gruschy, Lisa

AU - Brasso, Klaus

AU - Gerds, Thomas Alexander

AU - Kjær, Andreas

AU - Brooks, James D.

AU - Iversen, Peter

PY - 2018

Y1 - 2018

N2 - Background: It can be challenging to predict the risk of biochemical recurrence (BR) during follow-up after radical prostatectomy (RP) in men who have undetectable prostate-specific antigen (PSA), even years after surgery. Objective: To establish and validate a contemporary nomogram that predicts the absolute risk of BR every year after RP in men with undetectable PSA while accounting for competing risks of death. Design, setting, and participants: A total of 3746 patients from Rigshospitalet (Copenhagen, Denmark) and Stanford Urology (Stanford, CA, USA) who underwent RP between 1995 and 2013 were included. Outcome measurements and statistical analysis: Time to BR was defined as the first PSA result ≥0.2 ng/ml. BR risk was computed using multiple cause-specific Cox regression including preoperative PSA, pT category, RP Gleason score (GS), and surgical margin (R) status. Death without BR was considered a competing event. The nomogram presents the future risk of BR for a man who is alive and without BR at the time of follow-up. Validation assessed the discrimination and accuracy using time-dependent area under the curve and Brier scores. Results and limitations: The nomogram predicts risk of BR up to 12 yr after RP at an individual level. As example, the risk of BR for a man with pT3a, R-, GS 3 + 4, and preoperative PSA ≤10 ng/ml followed for 5 yr with undetectable PSA is 18% for the next 5 yr. External validation demonstrated both high accuracy and discrimination. The CPC Risk Calculator is available as a free Android and iOS App. Declining discrimination and accuracy after 7 yr of follow-up is the main limitation. Conclusions: This nomogram can be used as a tool to inform men with undetectable PSA during follow-up after RP about their future risk of BR, and may aid in decisions on the necessity for further follow-up. The nomogram is the first to be available as a free app. Patient summary: We developed an easily interpretable nomogram to evaluate the risk of prostate-specific antigen elevation (cancer recurrence) following complete removal of the prostate (radical prostatectomy). The tool can aid both physicians and patients in evaluating the future risk of cancer recurrence during follow-up after surgery. The model is available as a free mobile app that can be downloaded from the App Store. The CPC Risk Calculator is a new app that can help to predict the risk of biochemical recurrence during follow-up after radical prostatectomy.

AB - Background: It can be challenging to predict the risk of biochemical recurrence (BR) during follow-up after radical prostatectomy (RP) in men who have undetectable prostate-specific antigen (PSA), even years after surgery. Objective: To establish and validate a contemporary nomogram that predicts the absolute risk of BR every year after RP in men with undetectable PSA while accounting for competing risks of death. Design, setting, and participants: A total of 3746 patients from Rigshospitalet (Copenhagen, Denmark) and Stanford Urology (Stanford, CA, USA) who underwent RP between 1995 and 2013 were included. Outcome measurements and statistical analysis: Time to BR was defined as the first PSA result ≥0.2 ng/ml. BR risk was computed using multiple cause-specific Cox regression including preoperative PSA, pT category, RP Gleason score (GS), and surgical margin (R) status. Death without BR was considered a competing event. The nomogram presents the future risk of BR for a man who is alive and without BR at the time of follow-up. Validation assessed the discrimination and accuracy using time-dependent area under the curve and Brier scores. Results and limitations: The nomogram predicts risk of BR up to 12 yr after RP at an individual level. As example, the risk of BR for a man with pT3a, R-, GS 3 + 4, and preoperative PSA ≤10 ng/ml followed for 5 yr with undetectable PSA is 18% for the next 5 yr. External validation demonstrated both high accuracy and discrimination. The CPC Risk Calculator is available as a free Android and iOS App. Declining discrimination and accuracy after 7 yr of follow-up is the main limitation. Conclusions: This nomogram can be used as a tool to inform men with undetectable PSA during follow-up after RP about their future risk of BR, and may aid in decisions on the necessity for further follow-up. The nomogram is the first to be available as a free app. Patient summary: We developed an easily interpretable nomogram to evaluate the risk of prostate-specific antigen elevation (cancer recurrence) following complete removal of the prostate (radical prostatectomy). The tool can aid both physicians and patients in evaluating the future risk of cancer recurrence during follow-up after surgery. The model is available as a free mobile app that can be downloaded from the App Store. The CPC Risk Calculator is a new app that can help to predict the risk of biochemical recurrence during follow-up after radical prostatectomy.

KW - Biochemical recurrence

KW - Competing risk

KW - Prostate cancer

KW - Radical prostatectomy

KW - Validation

U2 - 10.1016/j.euf.2016.11.014

DO - 10.1016/j.euf.2016.11.014

M3 - Journal article

C2 - 28753827

AN - SCOPUS:85008179573

VL - 4

SP - 360

EP - 368

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

IS - 3

ER -