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A Nomogram Predicting 10-Year Life Expectancy in Candidates for Radical Prostatectomy or Radiotherapy for Prostate Cancer

Jochen Walz, Andrea Gallina, Fred Saad, Francesco Montorsi, Paul Perrotte, Shahrokh F. Shariat, Claudio Jeldres, Markus Graefen, Francois Bénard, Michael McCormack, Luc Valiquette, Pierre I. Karakiewicz

From the Cancer Prognostics and Health Outcomes Unit; Department of Urology, University of Montreal, Montreal, Quebec, Canada; Department of Urology; Martini Clinic, Prostate Cancer Center, University Medical Centre Eppendorf, Hamburg, Germany; Department of Urology, Vita-Salute University, Milan, Italy; and the Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX

Address reprint requests to Pierre I. Karakiewicz, MD, FRCSC, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montréal, Québec, Canada H2X 3J4; e-mail: pierre.karakiewicz{at}umontreal.ca

Purpose: Candidates for definitive therapy for localized prostate cancer (PCa) should have life expectancy (LE) in excess of 10 years. However, LE estimation is difficult. To circumvent this problem, we developed a nomogram predicting 10-year LE for patients treated with either radical prostatectomy (RP) or external-beam radiation therapy (EBRT) and compared it with an existing tool.

Patients and Methods: Between 1989 and 2000, 9,131 men were treated with either RP (n = 5,955) or EBRT (n = 3,176), without any secondary therapy and all deaths were considered unrelated to PCa. Age and Charlson comorbidity index (CCI) predicted 10-year LE in Cox regression models. We used 200 bootstrap resamples to internally validate the nomogram.

Results: Median age was 66 years, median CCI was 1, median follow-up was 5.9 years and median actuarial survival was 13.8 years. Advanced age (P < .001), elevated CCI score (P < .001) and treatment type (EBRT v RP, P < .001) were independent predictors of poor 10 year LE. The nomogram predicting 10 year LE after either RP or EBRT was 84.3% accurate in split sample validation and was 2.9% (P = .007) more accurate than the existing tool. A cutoff of 70% or less was 84% accurate in identifying men who did not survive beyond 10 years.

Conclusion: Our nomogram can accurately identify those individuals who do not have sufficient LE to warrant definitive PCa treatment and can help optimizing therapy decision-making.

J.W. and A.G. contributed equally to this article.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Editorial

• Predicting Outcomes in Prostate Cancer: How Many More Nomograms Do We Need?
  Robert W. Ross and Philip W. Kantoff
  JCO 2007 25: 3563-3564 [Full Text]

Related Correspondence

• Life Expectancy Estimation by Nomogram
  Michael Froehner
  JCO 2008 26: 690 [Full Text]
• Family Physicians Could Help in Predicting Life Expectancy Without Prostate Cancer
  Ravinder Mohan
  JCO 2008 26: 690-691 [Full Text]

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