Prediction Model Articles


  • 68Ga-PSMA-11 PET has the potential to improve patient selection for extended pelvic lymph node dissection in intermediate to high-risk prostate cancer.

    Radical prostatectomy with extended pelvic lymph node dissection (ePLND) is a curative treatment option for patients with clinically significant localised prostate cancer. The decision to perform an ePLND can be challenging because the overall incidence of lymph node metastasis is relatively low and ePLND is not free of complications.

    Published September 17, 2019
  • A Tool for Shared Decision Making on Referral for Prostate Biopsy in the Primary Care Setting: Integrating Risks of Cancer with Life Expectancy.

    Prostate cancer (PCa) testing involves a complex individually based decision-making process. It should consider competing risks from other comorbidities when estimating a survival benefit from the early detection of clinically significant (cs)PCa.

    Published May 1, 2019
  • Accurate prediction tools in prostate cancer require consistent assessment of included variables.

    OBJECTIVE - The aim of this study was to create a preoperative prediction model predicting extraprostatic tumour growth in men with clinically organ-confined disease from a prospectively collected Swedish cohort.

    Published April 9, 2016
  • An Integrated Score and Nomogram Combining Clinical and Immunohistochemistry Factors to Predict High ISUP Grade Clear Cell Renal Cell Carcinoma.

    Objective: The International Society of Urological Pathology (ISUP) has proposed a grading system to classify renal cell carcinoma (RCC). However, classification using biopsy specimens remains problematic and, consequently, the accuracy of a biopsy-based diagnosis is relatively poor.

    Published January 31, 2019
  • Assessing a Patient's Individual Risk of Biopsy-detectable Prostate Cancer: Be Aware of Case Mix Heterogeneity and A Priori Likelihood.

    The relation between prostate-specific antigen (PSA) and other relevant prebiopsy information is often combined in a risk calculator (RC). If the setting for RC use differs from that in which it was developed, there is a risk of making clinical decisions based on incorrect estimates of the absolute risk.

    Published August 23, 2019
  • Development and internal validation of a multivariable prediction model for biochemical failure after whole-gland salvage iodine-125 prostate brachytherapy for recurrent prostate cancer.

    Localized recurrent prostate cancer after primary radiotherapy can be curatively treated using salvage iodine-125 ((125)I) brachytherapy. Selection is hampered by a lack of predictive factors for cancer control.

    Published March 15, 2016
  • Development and Validation of a Comprehensive Multivariate Dosimetric Model for Predicting Late Genitourinary Toxicity Following Prostate Cancer Stereotactic Body Radiotherapy.

    Purpose: Dosimetric predictors of toxicity after Stereotactic Body Radiation Therapy (SBRT) are not well-established. We sought to develop a multivariate model that predicts Common Terminology Criteria for Adverse Events (CTCAE) late grade 2 or greater genitourinary (GU) toxicity by interrogating the entire dose-volume histogram (DVH) from a large cohort of prostate cancer patients treated with SBRT on prospective trials.

    Published June 17, 2020
  • Establishing a prediction model of infection during the intravesical instillation of bladder cancer: a multicenter retrospective study.

    Objective: To explore the independent risk factors of infection during the intravesical instillation of bladder cancer and establish a prediction model, which may reduce probability of infection for bladder cancer patients.

    Published June 12, 2020
  • Identification of a rectal subregion highly predictive of rectal bleeding in prostate cancer IMRT.

    To identify rectal subregions at risks (SRR) highly predictive of 3-year rectal bleeding (RB) in prostate cancer IMRT.

    Overall, 173 prostate cancer patients treated with IMRT/IGRT were prospectively analyzed, divided into "training" (n=118) and "validation" cohorts (n=53).

    Published May 17, 2016
  • Improving prediction models with new markers: a comparison of updating strategies.

    New markers hold the promise of improving risk prediction for individual patients. We aimed to compare the performance of different strategies to extend a previously developed prediction model with a new marker.

    Published October 7, 2016
  • Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculator for Initial Prostate Biopsy by Incorporating the 2014 International Society of Urological Pathology Gleason Grading and Cribriform growth.

    The survival rate for men with International Society of Urological Pathology (ISUP) grade 2 prostate cancer (PCa) without invasive cribriform (CR) and intraductal carcinoma (IDC) is similar to that for ISUP grade 1.
    Published July 25, 2017
  • Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculator for Initial Prostate Biopsy by Incorporating the 2014 ISUP Gleason Grading and Cribriform growth: Beyond the Abstract

    Population-wide screening with PSA reduces the mortality of prostate cancer (PCa) but with the downside of overdiagnosis and overtreatment [1, 2]. Men considering a PSA test would like to be informed about their benefits, possibilities and extent of overdiagnosis and overtreatment [3]. However, candidates for testing are only willing to accept a small increase of their chance of dying from PCa when considering reducing their chance on overdiagnosis and potential overtreatment [4]. Multivariable risk-based stratification for screening, as put forward by the European Randomized Study of Screening for Prostate Cancer section Rotterdam Risk Calculator (ERSPC-RC), has the potential for informed decision making [5]. But, as stated by Pruthi et al., risk assessment tools do have some shortcomings, which reinforces the need for continuous updating and adaptations of the devices [6]. Within the current study we aimed to improve our ERSPC-RC by incorporating contemporary pathologic biopsy classifications that better reflect disease burden [7].

    Especially the course of disease of Gleason score 7 prostate cancer is heterogeneous. Kweldam et al.  found that the presence of a cribriform pattern (CR) and intraductal carcinoma (IDC) in Gleason 7 radical prostatectomy specimen are major predictive factors for the occurrence of distant metastases and also are related to prostate cancer-specific death [8]. This observation was confirmed when looking at this growth patterns in biopsy specimen. There it was shown that men with Gleason 7 on biopsy without the presence of CR and IDC had similar 15-year biochemical recurrence-free survival rates as compared with low-risk prostate cancer patients (Gleason 6) [9]. More accurate disease classification based on biopsy specimen is indispensable for treatment decision making. 

    We therefore decided to update the ERSPC-RC with these new insights. While improvement in risk prediction is mostly sought by adding new potentially relevant predictors to the model, we attempted to refine our predictions by including the in 2014 updated International Society of Urological Pathology Gleason Grading (ISUP) system and info on CR/IDC presence into the original calculator ERSPC-RC3. By doing so, we aim to better distinguish (lethal) clinically relevant PCa from indolent PCa (Figure 1). 

    Screen Shot 2017 07 25 at 1.28.25 PM
    Figure 1.
     The original risk calculator in comparison with the improved ERSPC-Cribriform-RC including cribriform pathological findings. The improved RC distinguishes better clinically relevant PCa and reduces the number of missed diagnosis of clinical relevant. PSA: Prostate Specific Antigen, DRE: Digital Rectal Exam, PV: Prostate Volume measured by DRE, ISUP: International Society of Urological Pathology. 

    The ERSPC-Cribriform-RC is a practical and easy-to-use risk calculator (Figure 2). The urologist only has to know the patient’s age, PSA result and findings of the digital rectal examination (DRE). DRE provides information whenever a node is present and gives an estimate of prostate volume, which is sufficient to be of aid in better predicting biopsy outcome. 

    Screen Shot 2017 07 25 at 1.28.54 PM
    Figure 2. Prostate cancer risk calculators can be found at or as an app for your smartphone at the Appstore “Prostate cancer risk calculators”. There you can fill in the patient’s information. The risk calculator will provide for the probability of having clinical significant PCa and advice about biopsy.

    With the use of the ERSPC-Cribriform-RC, the urologist can substantially reduce the number of patients undergoing biopsy and at the same time minimize overdiagnosis. The current study shows that the use of the improved ERSPC-Cribriform-RC diminishes overdiagnosis with 34% while the percentage of missed diagnosis of clinically relevant PCa is 2%, which is a considerable improvement as compared to the original ERSPC-RC. Since this RC requires relatively easy retrieving information, general practitioners should also be able to use this tool and as such reduce the number of referrals. 

    To answer the patient’s question if he has a life-threatening PCa or not, just a simple PSA test is not enough. Combining relevant clinical characteristics and new pathological insights increases predictive ability. Most likely new developments like magnetic resonance imaging techniques, proteomics and/or genomics will provide more relevant pre-biopsy information that needs to be incorporated in future prediction tools. 

    Written by: Jan FM Verbeek, MD, Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands 

    Read the Abstract


    [1] Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. The Lancet. 2014;384:2027-35.
    [2] Loeb S, Bjurlin MA, Nicholson J, et al. Overdiagnosis and overtreatment of prostate cancer. European urology. 2014;65:1046-55.
    [3] Moynihan R, Nickel B, Hersch J, et al. Public opinions about overdiagnosis: A national community survey. PLoS One. 2015;10:e0125165.
    [4] Howard K, Salkeld GP, Patel MI, Mann GJ, Pignone MP. Men's preferences and trade-offs for prostate cancer screening: a discrete choice experiment. Health Expect. 2015;18:3123-35.
    [5] Roobol MJ, Verbeek JF, van der Kwast T, Kümmerlin IP, Kweldam CF, van Leenders GJ. Improving the ERSPC risk calculator for initial prostate biopsy incorporating the 2014 International Society of Urological Pathology Gleason grading and cribriform growth. European urology. 2017.
    [6] Pruthi DK, Ankerst DP, Liss MA. Novel definitions of low-risk and high-risk prostate cancer: Implications for the European Randomized Study of Screening for Prostate Cancer Risk Assessment Tool. European urology. 2017.
    [7] Kweldam CF, Kümmerlin IP, Nieboer D, et al. Prostate cancer outcomes of men with biopsy Gleason score 6 and 7 without cribriform or intraductal carcinoma. European ournal of cancer. 2016;66:26-33
    [8] Kweldam CF, Wildhagen MF, Steyerberg EW, Bangma CH, van der Kwast TH, van Leenders GJ. Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer. Modern pathology. 2015;28:457-64.
    [9] Kweldam CF, Kümmerlin IP, Nieboer D, et al. Disease-specific survival of patients with invasive cribriform and intraductal prostate cancer at diagnostic biopsy. Modern pathology. 2016;29:630-6.
    Published July 25, 2017
  • Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience.

    The prediction of post-prostatectomy incontinence (PPI) after robot-assisted radical prostatectomy (RARP) depends on multiple clinical, anatomical and surgical factors. There are only few risk formulas, tables or nomograms predicting PPI that may assist clinicians and their patients in adequate risk counseling on postoperative side-effects.

    Published September 20, 2020
  • Prognostic analysis of postoperative clinically nonmetastatic renal cell carcinoma.

    To investigate the survival characteristics of postoperative nonmetastatic renal cell carcinoma (RCC) patients, and the predictive value of a prognostic model.

    We retrospectively evaluated data from 1202 postoperative nonmetastatic RCC patients who were treated between 1999 and 2012 at West China Hospital, Sichuan University (Chengdu, China).

    Published January 3, 2020
  • Risk Prediction Tool for Aggressive Tumors in Clinical T1 Stage Clear Cell Renal Cell Carcinoma Using Molecular Biomarkers.

    Some early-stage clear cell renal cell carcinomas (ccRCCs) of ≤7 cm are associated with a poor clinical outcome. In this study, we investigated molecular biomarkers associated with aggressive clinical T1 stage ccRCCs of ≤7 cm, which were used to develop a risk prediction tool toward guiding the decision of treatment.

    Published April 11, 2019
  • Stress urinary incontinence after vaginal prolapse repair: development and internal validation of a prediction model with and without the stress test.

    To develop a prediction model for stress urinary incontinence (SUI) after vaginal prolapse repair (postoperative stress urinary incontinence [POSUI]) and assess the value of a preoperative stress test.

    Published March 10, 2019
  • Whole-body MRI-based multivariate prediction model in the assessment of bone metastasis in prostate cancer.

    A whole-body MRI (WB-MRI) including T1, short time inversion recovery (STIR), diffusion-weighted imaging (high b value) was applied in our center for the detection of bone metastasis in prostate cancer (PCa) patients.

    Published February 3, 2021