Preoperative Nomograms for Predicting Extracapsular Extension in Korean Men with Localized Prostate Cancer: A Multi-institutional Clinicopathologic Study

Abstract

We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.

Development and external validation of a biopsy‐derived nomogram to predict risk of ipsilateral extraprostatic extension

“…Given that at least 20% of men currently undergoing RP for presumed localized disease are noted to have EPE , the accurate prediction of preoperative EPE risk is of clinical importance to help surgeons better select patients for a nerve‐sparing vs non‐nerve sparing approach. Although previous attempts have been made to predict risk of EPE using preoperative markers , a model with improved predictive accuracy and generalizability/external validity is still needed. In the present study we used a number of preoperative markers to develop, and subsequently externally validate, a nomogram that predicts risk of side‐specific EPE at time of surgery.…”

Yonsei nomogram to predict lymph node invasion in Asian men with prostate cancer during robotic era

“…For nomograms in Asian populations, several investigators have developed predictive models for pathological stage of clinically localised prostate cancer . Two of these nomograms were able to predict LN metastases with relatively high accuracy .…”

Divorcing Diagnosis From Treatment: Contemporary Management of Low-Risk Prostate Cancer

“…These data are based on the difference between preoperative biopsy and final pathology at the time of radical prostatectomy (RP), which highlights the importance of a second confirmatory biopsy in selecting men who would be candidates for surveillance. Biopsy Gleason sum as well as the number or percentage of biopsy cores with cancer have all been found to independently predict risk of extracapsular extension, as shown in one study of Korean men who underwent prostatectomy for localized prostate cancer [27]. Importantly, no method exists that can predict disease progression or aggressiveness with complete accuracy.…”

“…There is an established disparity in incidence and prostate cancer aggressiveness between Western and Asian nations [27], which puts into question the safety and efficacy of AS in these populations. Recent reports from Japanese [28] and South Korean [29] cohorts that identified men with low-risk disease who met the PRIAS (Prostate Cancer Research International: Active Surveillance) criteria (Gleason score, ≤6; T1c.T2; PSA, <10 ng/mL; PSA density, <0.2; <2 positive cores) reported similar rates of unfavorable pathologic outcomes as compared with Western studies.…”

“…Recent reports from Japanese [28] and South Korean [29] cohorts that identified men with low-risk disease who met the PRIAS (Prostate Cancer Research International: Active Surveillance) criteria (Gleason score, ≤6; T1c.T2; PSA, <10 ng/mL; PSA density, <0.2; <2 positive cores) reported similar rates of unfavorable pathologic outcomes as compared with Western studies. Nonetheless, profiles of "insignificant disease" in Asian men appear to be unique [27]; thus, validation of optimal selection criteria is warranted.…”