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.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal QC Canada

Department of Urology 2nd Faculty of Medicine Charles University Prag Czechia

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Department of Urology University of Naples Federico 2 Naples Italy

Department of Urology University of Texas Southwestern Dallas TX United States

Departments of Urology Weill Cornell Medical College New York NY United States

Division of Experimental Oncology Unit of Urology URI Urological Research Institute Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute Milan Italy

Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

Zobrazit více v PubMed

COVID-19 . Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (Accessed April 29, 2020).

De Lorenzo R, Magnaghi C, Cinel E, Vitali G, Martinenghi S, Mazza MG, et al. . A nomogram-based model to predict respiratory dysfunction at 6 months in non-critical COVID-19 survivors. Front Med (Lausanne) (2022) 9:781410. doi: 10.3389/fmed.2022.781410 PubMed DOI PMC

Surgeons ACo . COVID-19: recommendations for management of elective surgical procedures 2020. Available at: www.facs.org/about-acs/covid-19/information-for-surgeons.

Katz EG, Stensland KS, Mandeville JA, MacLachlan LS, Moinzadeh A, Sorcini A, et al. . Triaging office-based UrologY procedures during the COVID-19 pandemic. J Urol (2020) 204(1):9–10. doi: 10.1097/JU.0000000000001034:101097JU0000000000001034 PubMed DOI PMC

Stensland KD, Morgan TM, Moinzadeh A, Lee CT, Briganti A, Catto JWF, et al. . Considerations in the triage of urologic surgeries during the COVID-19 pandemic. Eur Urol (2020) 77(6):663–6. doi: 10.1016/j.eururo.2020.03.027 PubMed DOI PMC

Ahmed K, Hayat S, Dasgupta P. Global challenges to urology practice during the COVID-19 pandemic. BJU Int (2020) 125(6):E5–6. doi: 10.1111/bju.15082 PubMed DOI PMC

Carneiro A, Wroclawski ML, Nahar B, Soares A, Cardoso AP, Kim NJ, et al. . Impact of the COVID-19 pandemic on the urologist’s clinical practice in Brazil: A management guideline proposal for low- and middle-income countries during the crisis period. Int Braz J Urol (2020) 46(4):501–10. doi: 10.1590/s1677-5538.ibju.2020.04.03 PubMed DOI PMC

Ficarra V, Novara G, Abrate A, Bartoletti R, Crestani A, De Nunzio C, et al. . Urology practice during the COVID-19 pandemic. Minerva Urol Nefrol (2020) 72(3):369–75. doi: 10.23736/S0393-2249.20.03846-1 PubMed DOI

Goldman HB, Haber GP. Recommendations for tiered stratification of urological surgery urgency in the COVID-19 era. J Urol (2020) 204(1):11–3. doi: 10.1097/JU.0000000000001067 PubMed DOI PMC

Heldwein FL, Loeb S, Wroclawski ML, Sridhar AN, Carneiro A, Lima FS, et al. . A systematic review on guidelines and recommendations for urology standard of care during the COVID-19 pandemic. Eur Urol Focus (2020) 6(5):1070–85. doi: 10.1016/j.euf.2020.05.020 PubMed DOI PMC

Kutikov A, Weinberg DS, Edelman MJ, Horwitz EM, Uzzo RG, Fisher RI. A war on two fronts: Cancer care in the time of COVID-19. Ann Intern Med (2020) 172(11):756–8. doi: 10.7326/M20-1133 PubMed DOI PMC

Mottrie A. EAU robotic urology section (ERUS) guidelines during COVID-19 emergency . Available at: https://uroweb.org/wp-content/uploads/ERUS-guidelines-for-COVID-def.pdf.

Ribal MJ, Cornford P, Briganti A, Knoll T, Gravas S, Babjuk M, et al. . European Association of urology guidelines office rapid reaction group: An organisation-wide collaborative effort to adapt the European association of urology guidelines recommendations to the coronavirus disease 2019 era. Eur Urol (2020) 78(1):21–8. doi: 10.1016/j.eururo.2020.04.056 PubMed DOI PMC

Mohler JL, Antonarakis ES, Armstrong AJ, D’Amico AV, Davis BJ, Dorff T, et al. . Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw (2019) 17(5):479–505. PubMed

Zumsteg ZS, Chen Z, Howard LE, Amling CL, Aronson WJ, Cooperberg MR, et al. . Modified risk stratification grouping using standard clinical and biopsy information for patients undergoing radical prostatectomy: Results from SEARCH. Prostate (2017) 77(16):1592–600. doi: 10.1002/pros.23436 PubMed DOI PMC

Yang DD, Mahal BA, Muralidhar V, Nezolosky MD, Vastola ME, Labe SA, et al. . Risk of upgrading and upstaging among 10 000 patients with Gleason 3 + 4 favorable intermediate-risk prostate cancer. Eur Urol Focus (2019) 5(1):69–76. doi: 10.1016/j.euf.2017.05.011 PubMed DOI

Nocera L, Colla Ruvolo C, Stolzenbach LF, Deuker M, Tian Z, Gandaglia G, et al. . Improving the stratification of intermediate risk prostate cancer. Minerva Urol Nephrol (2021) 74(5):590–8. doi: 10.23736/S2724-6051.21.04314-7 PubMed DOI

Stolzenbach LF, Nocera L, Colla-Ruvolo C, Tian Z, Knipper S, Maurer T, et al. . Improving the stratification of patients with intermediate-risk prostate cancer. Clin Genitourin Cancer (2021) 19(2):e120–8. doi: 10.1016/j.clgc.2020.11.003 PubMed DOI

About the SEER program. Available at: https://seer.cancer.gov/about/overview.html.

Preisser F, Bandini M, Nazzani S, Mazzone E, Marchioni M, Tian Z, et al. . Development and validation of a lookup table for the prediction of metastatic prostate cancer according to prostatic-specific antigen value, clinical tumor stage, and Gleason grade groups. Eur Urol Oncol (2020) 3(5):631–9. doi: 10.1016/j.euo.2019.03.003 PubMed DOI

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics (1988) 44(3):837–45. doi: 10.2307/2531595 PubMed DOI

Vickers AJ, Elkin EB. Decision curve analysis: A novel method for evaluating prediction models. Med Decis Making (2006) 26(6):565–74. doi: 10.1177/0272989X06295361 PubMed DOI PMC

RCT . R: A language and environment for statistical computing. (Vienna, Austria: R Foundation for Statistical Computing; ) (2017).

Gandaglia G, Ploussard G, Valerio M, Mattei A, Fiori C, Roumiguie M, et al. . The key combined value of multiparametric magnetic resonance imaging, and magnetic resonance imaging-targeted and concomitant systematic biopsies for the prediction of adverse pathological features in prostate cancer patients undergoing radical prostatectomy. Eur Urol (2020) 77(6):733–41. doi: 10.1016/j.eururo.2019.09.005 PubMed DOI

Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S, et al. . Predicting the presence and side of extracapsular extension: A nomogram for staging prostate cancer. J Urol (2004) 171(5):1844–9. doi: 10.1097/01.ju.0000121693.05077.3d PubMed DOI

Martini A, Gupta A, Lewis SC, Cumarasamy S, Haines KG, 3rd, Briganti A, et al. . Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer. BJU Int (2018) 122(6):1025–33. doi: 10.1111/bju.14353 PubMed DOI

Gandaglia G, Fossati N, Zaffuto E, Bandini M, Dell’Oglio P, Bravi CA, et al. . Development and internal validation of a novel model to identify the candidates for extended pelvic lymph node dissection in prostate cancer. Eur Urol (2017) 72(4):632–40. doi: 10.1016/j.eururo.2017.03.049 PubMed DOI

Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ, Dotan ZA, Fearn PA, et al. . Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst (2006) 98(10):715–7. doi: 10.1093/jnci/djj190 PubMed DOI PMC

Nasri J, Barthe F, Parekh S, Ratnani P, Pedraza AM, Wagaskar VG, et al. . Nomogram predicting adverse pathology outcome on radical prostatectomy in low-risk prostate cancer men. Urology (2022) 166:189–95. doi: 10.1016/j.urology.2022.02.019 PubMed DOI

Zelic R, Garmo H, Zugna D, Stattin P, Richiardi L, Akre O, et al. . Predicting prostate cancer death with different pretreatment risk stratification tools: A head-to-head comparison in a nationwide cohort study. Eur Urol (2020) 77(2):180–8. doi: 10.1016/j.eururo.2019.09.027 PubMed DOI

Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. . MRI-Targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med (2018) 378(19):1767–77. doi: 10.1056/NEJMoa1801993 PubMed DOI PMC

Panebianco V, Valerio MC, Giuliani A, Pecoraro M, Ceravolo I, Barchetti G, et al. . Clinical utility of multiparametric magnetic resonance imaging as the first-line tool for men with high clinical suspicion of prostate cancer. Eur Urol Oncol (2018) 1(3):208–14. doi: 10.1016/j.euo.2018.03.008 PubMed DOI

Brimo F, Schultz L, Epstein JI. The value of mandatory second opinion pathology review of prostate needle biopsy interpretation before radical prostatectomy. J Urol (2010) 184(1):126–30. doi: 10.1016/j.juro.2010.03.021 PubMed DOI

Bravi CA, Vertosick E, Tin A, Scuderi S, Fallara G, Rosiello G, et al. . Relative contribution of sampling and grading to the quality of prostate biopsy: Results from a single high-volume institution. Eur Urol Oncol (2018). doi: 10.1016/j.euo.2018.10.007 PubMed DOI PMC