Prediction of clinical progression after radical prostatectomy in a nationwide population-based cohort

The aim of this study was to create a model for predicting progression-free survival after radical prostatectomy for localized prostate cancer.

The risk of biochemical recurrence (BCR) was modelled in a cohort of 3452 men aged 70 years or younger who were primarily treated with radical prostatectomy after being diagnosed between 2003 and 2006 with localized prostate cancer [clinical stage T1c-T2, Gleason score 5-10, N0/NX, M0/MX, prostate-specific antigen (PSA) < 20 ng/ml]. The cohort was split into two: one cohort for model development (n = 3452) and one for validation (n = 1762). BCR was defined as two increasing PSA values of at least 0.2 ng/ml, initiation of secondary therapy, distant metastases or death from prostate cancer. Multivariable Cox proportional hazard regression was applied, predictive performance was assessed using the bootstrap resampling technique to calculate the c index, and calibration of the model was evaluated by comparing predicted and observed Kaplan-Meier 1 year BCR.

The overall 5 year progression-free survival was 83% after a median follow-up time of 6.8 years in the development cohort and 7.3 years in the validation cohort. The final model included T stage, PSA level, primary and secondary Gleason grade, and number of positive and negative biopsies. The c index for discrimination between high and low risk of recurrence was 0.68. The probability of progression-free survival ranged from 22% to 97% over the range of risk scores in the study population.

This model is based on nationwide population-based data and can be used with a fair predictive accuracy to guide decisions on clinical follow-up after prostatectomy. An online calculator for convenient clinical use of the model is available at

Scandinavian journal of urology. 2016 May 18 [Epub ahead of print]

Anders Bjartell, Matteo Bottai, Josefin Persson, Ola Bratt, Jan-Erik Damber, Pär Stattin, Olof Akre

a Department of Urology , Skåne University Hospital , Malmö , Sweden ;, c Unit of Biostatistics, Institute of Environmental Medicine , Karolinska Institutet , Stockholm , Sweden ;, d Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden ;, b Department of Translational Medicine, Division of Urological Cancers , Lund University , Sweden ;, f Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy, University of Gothenburg , Sweden ;, g Department of Surgical Sciences , Uppsala University , Uppsala , Sweden ;, i Department of Medicine Solna, Karolinska Institutet, and Department of Urology , Karolinska University Hospital , Stockholm , Sweden.


Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.