Shared decision-making for localized prostate cancer (PCa) requires understanding how baseline factors predict patient-reported outcomes (PROs) after treatment. Most prior predictive models are limited by small, single-region cohorts. We sought to develop and evaluate models predicting 12-month PROs using the large, multi-national Movember True North Global Registry (TNGR).
We identified 27,499 men with localized PCa across 15 countries (2016-2022). Patients were randomly split into training (n = 18,332) and validation (n = 9,167) cohorts. Multivariable linear regressions incorporated baseline PROs, demographics, country, primary treatment (active surveillance, radical prostatectomy, external-beam radiotherapy ± androgen-deprivation therapy, or brachytherapy), and tumor characteristics (grade, stage, percent positive biopsy cores, PSA). Outcomes were changes from baseline to 12 months across 5 EPIC-26 domains.
Baseline function, treatment modality, and tumor features were associated with 12-month changes across domains. When applied to the validation cohort, model performance explained 15%, 14%, 19%, 32%, and 28% of variance in urinary incontinence, irritative urinary, bowel, sexual, and hormonal function, respectively.
In this first global analysis of functional outcomes after PCa treatment, predictive accuracy was modest, reflecting substantial regional and practice heterogeneity. These findings underscore both the limits of universal prediction models and the value of large-scale international data for benchmarking outcomes. Future TNGR work will focus on region-specific and locally calibrated models to support more personalized counseling and quality-improvement initiatives.
Clinical genitourinary cancer. 2026 Jan 16 [Epub ahead of print]
Adam B Weiner, Shannon C Martin, Holly Wilhalme, Anissa V Bailey, Lorna Kwan, Bashir Al Hussein Al Awamlh, Zhiguo Zhao, Paolo Verze, Juliet Ippolito, Roberto La Rocca, Nora Tabea Sibert, Daniel A Barocas, Thomas R Belin, David Elashoff, Christoph Kowalski, Claire Foster, Caroline Moore, Mark S Litwin, True North Global Registry
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: ., David Geffen School of Medicine, University of California, Los Angeles, CA., Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA., Department of Urology, Weill Cornell Medical College, New York, NY., Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN., Department of Medicine and Surgery, Odontostomatology "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy., Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy., Department of Urology, IRCSS Neuromed, Pozzilli (IS), Italy., Department of Health Services Research, German Cancer Society, Berlin, Germany; Department of Gynecology and Obstetrics, University Clinic Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany., Department of Urology, Vanderbilt University Medical Center, Nashville, TN., Department of Biostatistics, University of California, Los Angeles, CA., Department of Urology, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, University of California, Los Angeles, CA; Department of Computational Medicine, University of California, Los Angeles, CA., Department of Health Services Research, German Cancer Society, Berlin, Germany., Centre for Psychosocial Research in Cancer, University of Southampton, Southampton, UK., Division of Surgical and Interventional Sciences, University College London, London, UK., Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA; School of Nursing, University of California, Los Angeles, CA.