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. 2022 Dec 6:12:990851.
doi: 10.3389/fonc.2022.990851. eCollection 2022.

Predicting the probability of pT3 or higher pathological stage at radical prostatectomy: COVID19-specific considerations

Luigi Nocera  1   2 , Lara F Stolzenbach  1   3 , Claudia Collà Ruvolo  1   4 , Mike Wenzel  1   5 , Christoph Wurnschimmel  1   3 , Zhe Tian  1 , Giorgio Gandaglia  2 , Nicola Fossati  2 , Vincenzo Mirone  4 , Felix K H Chun  5 , Shahrokh F Shariat  6   7   8   9   10   11 , Markus Graefen  3 , Fred Saad  1 , Francesco Montorsi  2 , Alberto Briganti  2 , Pierre I Karakiewicz  1
Affiliations

Predicting the probability of pT3 or higher pathological stage at radical prostatectomy: COVID19-specific considerations

Luigi Nocera et al. Front Oncol. .

Abstract

Background: We tested whether a model identifying prostate cancer (PCa) patients at risk of pT3-4/pN1 can be developed for use during COVID19 pandemic, in order to guarantee appropriate treatment to patients harboring advanced disease patients without compromising sustainability of care delivery.

Methods: Within the Surveillance, Epidemiology and End Results database 2010-2016, we identified 27,529 patients with localized PCa and treated with radical prostatectomy. A multivariable logistic regression model predicting presence of pT3-4/pN1 disease was fitted within a development cohort (n=13,977, 50.8%). Subsequently, external validation (n=13,552, 49.2%) and head-to-head comparison with NCCN risk group stratification was performed.

Results: In model development, age, PSA, biopsy Gleason Grade Group (GGG) and percentage of positive biopsy cores were independent predictors of pT3-4/pN1 stage. In external validation, prediction of pT3-4/pN1 with novel nomogram was 74% accurate versus 68% for NCCN risk group stratification. Nomogram achieved better calibration and showed net-benefit over NCCN risk group stratification in decision curve analyses. The use of nomogram cut-off of 49% resulted in pT3-4/pN1 rate of 65%, instead of the average 35%.

Conclusion: The newly developed, externally validated nomogram predicts presence of pT3-4/pN1 better than NCCN risk group stratification and allows to focus radical prostatectomy treatment on individuals at highest risk of pT3-4/pN1.

Keywords: C19; PCA; PT3; Pt3+; pT4; prostate cancer; radical prostatectomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Model predicting the individual probability of pT3-4/pN1 at radical prostatectomy in prostate cancer patients.
Figure 2
Figure 2
Calibration plots of observed versus predicted rates of pT3-4/pN1 within the external validation cohort of prostate cancer patients for: (A) the newly developed model; (B) NCCN risk group stratification.
Figure 3
Figure 3
Decision curve analyses (DCA) demonstrating the net benefit associated with prediction of pT3-4/pN1 with the newly developed model versus a model based NCCN risk group stratification.
See this image and copyright information in PMC

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