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External validation of nomograms including MRI features for the prediction of side-specific extraprostatic extension

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). Multiple nomograms, which include magnetic resonance imaging (MRI) information, are available predict side-specific EPE. It is crucial that the accuracy of these nomograms is assessed with external validation to ensure they can be used in clinical practice to support medical decision-making.

Methods

Data of prostate cancer (PCa) patients that underwent robot-assisted RP (RARP) from 2017 to 2021 at four European tertiary referral centers were collected retrospectively. Four previously developed nomograms for the prediction of side-specific EPE were identified and externally validated. Discrimination (area under the curve [AUC]), calibration and net benefit of four nomograms were assessed. To assess the strongest predictor among the MRI features included in all nomograms, we evaluated their association with side-specific EPE using multivariate regression analysis and Akaike Information Criterion (AIC).

Results

This study involved 773 patients with a total of 1546 prostate lobes. EPE was found in 338 (22%) lobes. The AUCs of the models predicting EPE ranged from 72.2% (95% CI 69.1–72.3%) (Wibmer) to 75.5% (95% CI 72.5–78.5%) (Nyarangi-Dix). The nomogram with the highest AUC varied across the cohorts. The Soeterik, Nyarangi-Dix, and Martini nomograms demonstrated fair to good calibration for clinically most relevant thresholds between 5 and 30%. In contrast, the Wibmer nomogram showed substantial overestimation of EPE risk for thresholds above 25%. The Nyarangi-Dix nomogram demonstrated a higher net benefit for risk thresholds between 20 and 30% when compared to the other three nomograms. Of all MRI features, the European Society of Urogenital Radiology score and tumor capsule contact length showed the highest AUCs and lowest AIC.

Conclusion

The Nyarangi-Dix, Martini and Soeterik nomograms resulted in accurate EPE prediction and are therefore suitable to support medical decision-making.

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Fig. 1: Calibration slope for all four models.
Fig. 2: Decision–curve analysis for the four models.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands

    J. G. Heetman, L. Wever, H. H. E. Van Melick, R. C. N. Van den Bergh, T. F. W. Soeterik & T. Soeterik

  2. Department of Radiology, St. Antonius Hospital, Utrecht, The Netherlands

    E. J. R. J. van der Hoeven

  3. Department of Urology, Medical University of Vienna, Vienna, Austria

    P. Rajwa & S. Shariat

  4. Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

    F. Zattoni, F. Dal Moro, G. Novara, G. La Bombara & F. Sattin

  5. Department of Urology, University Hospital Essen, Essen, Germany

    C. Kesch, N. von Ostau & C. V. Kesch

  6. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    S. Shariat

  7. Department of Special Surgery, The University of Jordan, Amman, Jordan

    S. Shariat

  8. Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA

    S. Shariat

  9. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia

    S. Shariat

  10. Department of Urology, Weill Cornell Medical College, New York, USA

    S. Shariat

  11. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    N. Pötsch & P. A. T. Baltzer

  12. Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    J. P. A. Van Basten

  13. Unit of Urology/Division of Oncology, San Raffaele Hospital, Milan, Italy

    G. Gandaglia

  14. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

    T. F. W. Soeterik

  15. Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    L. Bianchi

  16. Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy

    F. Ceci

  17. Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China

    P. K-F. Chiu

  18. Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK

    F. Giganti

  19. Division of Surgery & Interventional Science, University College London, London, UK

    F. Giganti

  20. Department of Urology, Medical University of Innsbruck, Innsbruck, Austria

    I. Heidegger

  21. Division of Surgery and Interventional Science, University College London, London, UK

    V. Kasivisvanathan

  22. Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy

    G. Marra

  23. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    A. Martini

  24. Department of Urology, Lille University Hospital, Lille, France

    J. Olivier

  25. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany

    F. Preisser

  26. Akershus University Hospital, Oslo, Norway

    K. Aas

  27. Faculty of Medicine, University of Oslo, Oslo, Norway

    K. Aas

  28. Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy

    U. G. Falagario

  29. Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy

    V. Fasulo

  30. Department of Maternal-Infant and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy

    M. Maggi

  31. Department of Urology, Instituto de Investigación Biosanitaria ibs.Granada, Hospital Universitario Virgen de las Nieves (HUVN), Granada, Spain

    I. Puche Sanz

  32. Department of Urology, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany

    M. C. Roesch

  33. Department of Urology, University Hospital of Freiburg, Freiburg am Breisgau, Germany

    A. Sigle

  34. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    L. F. Stolzenbach

Authors
  1. J. G. Heetman
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  2. E. J. R. J. van der Hoeven
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  3. P. Rajwa
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  4. F. Zattoni
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  5. C. Kesch
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  6. S. Shariat
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  8. G. Novara
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  19. T. F. W. Soeterik
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Consortia

on behalf of the European Association of Urology Young Academic Urologists Prostate Cancer Working Party

  • Board Members

    • G. Gandaglia
    • , L. Bianchi
    • , F. Ceci
    • , P. K-F. Chiu
    • , F. Giganti
    • , I. Heidegger
    • , V. Kasivisvanathan
    • , C. V. Kesch
    • , G. Marra
    • , A. Martini
    • , J. Olivier
    • , F. Preisser
    • , P. Rajwa
    •  & F. Zattoni

  • Associates

    • K. Aas
    • , U. G. Falagario
    • , V. Fasulo
    • , M. Maggi
    • , I. Puche Sanz
    • , M. C. Roesch
    • , A. Sigle
    • , T. Soeterik
    •  & L. F. Stolzenbach

Contributions

Conception and design: TFWS. Acquistion of data: JGH, EJRJvan derH, PR, FZ, CK, SS, FDM, GN, GLB, FS, NvonO, NP, PATB, LW, HHEvM, RCNvandenB, GG, TFWS. Statistical analysis: JGH. Analysis and interpretation of data: JGH. Drafting of the manuscript: TFWS, JGH. Critical revision of the manuscript for important intellectual content: JGH, EJRJvanderH, PR, FZ, CK, SS, FDM, GN, GLB, FS, NvonO, NP, PATB, LW, JPAVB, HHEvanM, RCNvandenB, GG, TFWS. Supervision: TFWSoeterik.

Corresponding author

Correspondence to T. F. W. Soeterik.

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Competing interests

The authors declare no competing interests.

Ethics

The Medical research Ethics Committee United (METC-U) registered the study protocol under W18.055 and concluded that the study protocol was not subjected to the Human Subject Act. The METC-U concluded that informed consent was not needed.

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Heetman, J.G., van der Hoeven, E.J.R.J., Rajwa, P. et al. External validation of nomograms including MRI features for the prediction of side-specific extraprostatic extension. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00738-3

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