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Life Expectancy Estimation by Nomogram

Department of Urology, University Hospital "Carl Gustav Carus," Technical University of Dresden, Dresden, Germany

To the Editor:

I read with great interest the article by Walz et al¹ introducing a new nomogram predicting 10-year overall survival in men with early prostate cancer. This meritorious study was based on a huge sample with long-term follow-up. The way of patient selection, however, could be a source of bias that clinicians should keep in mind when applying the suggested nomogram. The authors included in the radiotherapy cohort-only patients without any hormonal manipulation. The overall survival curve in the resulting population compares unfavorably with other radiotherapy series^2,4 and even with expectant management series^3,4 and is similar to survival curves in men with severe comorbidity (Charlson score 2 or higher) treated by radiotherapy or expectant management in the pre-PSA–era.² It is conceivable that the exclusion of hormonal therapy additionally to radiotherapy selected a sample with a particularly poor prognosis (without clinical failure due to early death of competing causes). Therefore, the results of the study should be interpreted with caution. The conclusion that the developed nomogram may "accurately identify those individuals who do not have sufficient life expectancy to warrant definitive prostate cancer treatment" is possibly too optimistic.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Walz J, Gallina A, Saad F, et al: A nomogram predicting 10-year life expectancy in candidates for radical prostatectomy or radiotherapy for prostate cancer. J Clin Oncol 25:3576-3581, 2007[Abstract/Free Full Text]

2. Barry MJ, Albertsen PC, Bagshaw MA, et al: Outcomes for men with clinically nonmetastatic prostate carcinoma managed with radical prostactectomy, external beam radiotherapy, or expectant management: A retrospective analysis. Cancer 91:2302-2314, 2001[CrossRef][Medline]

3. Bolla M, Collette L, Blank L, et al: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): A phase III randomised trial. Lancet 360:103-106, 2002[CrossRef][Medline]

4. Albertsen PC, Hanley JA, Penson DF, et al: 13-year outcomes following treatment for clinically localized prostate cancer in a population based cohort. J Urol 177:932-936, 2007[CrossRef][Medline]

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