Table 3.
Prognostic tools relating to external beam radiation therapy
| Author | Model type | Variables | Variable readily available? | Validation (I/E) | Accuracy | Metric | Sample size (events) | Outcome | Tx |
|---|---|---|---|---|---|---|---|---|---|
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 6 | 0.54 | c-index | 2469 (NR) | OS | 3D-CRT, IMRT |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 7 | 0.54 | c-index | 2469 (NR) | OS | 3D-CRT, IMRT |
| Vainshtein [18] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.56 | c-index | 85 (NR) | PCSM | EBRT with long term Androgen deprivation |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 7 | 0.58 | c-index | 2469 (NR) | OS | 3D-CRT, IMRT |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 6 | 0.52 | c-index | 2469 (NR) | BCF | 3D-CRT, IMRT |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, tages. | Yes | External validation of AJCC version 7 | 0.6 | c-index | 2469 (NR) | BCF | 3D-CRT, IMRT |
| Vance [60] | Survival model (Cox) | PSA, Gleason, clinical T stage, PCV, ADT use | Yes | Not stated | 0.61 95% CI 0.53-0.68 | c-index | 599 (NR) | OS | EBRT |
| Buyyounouski [38] | Survival model | Interval to Biochemical failure (dicotomized at 18 months) | Yes | External validation of IBF | 0.61; 95% CI 0.58-0.65; 48.4%; 86.1% | c-index; sensitivity; specificity. | 1722 (290) | PCSM | EBRT |
| Westphalen [62] | Survival (Cox, Nomogram presented) | PSA level, clinical stage (from digital rectal examination findings), sum of Gleason grades, use of neoadjuvant ADT, and radiation dose | Yes | External validation of Kattan with additions | 0.61; 95% CI 0.581-0.640 | c-index | 99 (30) | BCF | EBRT |
| Qian [52] | Survival model (Cox) | NCCN risk stratification tool plus percent positive cores | Yes | Not stated | 0.63 | c-index | 652 (NR) | BFFF | 3D-CRT, IMRT |
| Vance [60] | Survival model (Cox) | PSA, Gleason, clinical T stage, PCV, ADT use | No (prostate cancer volume) | Not stated | 0.64; 95% CI 0.57-0.70 | c-index | 599 (NR) | BFFF | EBRT |
| Qian [52] | Survival model (Cox) | NCCN risk stratification tool plus percent positive cores | Yes | Not stated | 0.64 | c-index | 652 (NR) | Metastases | 3D-CRT, IMRT |
| Vainshtein [18] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.67 | c-index | 85 (NR) | BFFF | EBRT with long term Androgen deprivation |
| Zelefsky [66] | Survival (Cox, Nomogram presented) | ADT, T stage, Gleason, Pre PSA, RT dose. | Yes | Not stated | 0.67 | c-index | 2551 | BFFF | 3D-CRT, IMRT |
| Vance [60] | Survival model (Cox) | PSA, Gleason, clinical T stage, PCV, ADT use | No (prostate cancer volume) | Not stated | 0.67; 95% CI 0.60-0.74 | c-index | 599 (NR) | FFM | EBRT |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 6 | 0.68 | c-index | 2469 (NR) | PCSM | 3D-CRT, IMRT |
| Halverson [46] | Survival model (Cox) | CAPRA: PSA, T stage, Gleason score, percent positive biopsy, and age | Yes | External validation of CAPRA | 0.69 | c-index | 612 (NR) | BFFF | EBRT |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 6 | 0.70 | c-index | 2469 (NR) | DM | 3D-CRT, IMRT |
| Qian [52] | Survival model (Cox) | NCCN risk stratification tool plus percent positive cores | Yes | Not stated | 0.71 | c-index | 652 (NR) | PCSM | 3D-CRT, IMRT |
| Zelefsky [68] | Survival (Cox, Nomogram presented) | T stage, Gleason Score, radiation dose, Neoadjuvant ADT, Pre-treatment PSA level, | Yes | Internal (bootstrapping) | 0.72 | c-index | 2253 (578) | BCF | 3D-CRT, IMRT |
| Williams [17] | Survival (Cox, Nomogram presented) | Age, prostate-specific antigen value, Gleason score, clinical stage, androgen deprivation duration, and radiotherapy dose | Yes | Not stated | 0.72 | c-index | 3264 (1048) | BCF | EBRT |
| Vainshtein [18] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.73 | c-index | 153 (NR) | PCSM | EBRT with short term Androgen deprivation |
| Steigler [56] | Survival Model (Fine and Gray) | PSA doubling time (PSADT definition specified), time to biochemical failure, high risk category defined by PSADT <4 months or TTBF < 1 year and low risk category by PSADT >9 months or TTBF > 3 years. | Yes | Internal (bootstrapping) | 0.73 | c-index | 485 (150) | PCSM | EBRT |
| Vance [60] | Survival model (Cox) | PSA, Gleason, clinical T stage, PCV, ADT use | No (prostate cancer volume) | Not stated | 0.75; 95% CI 0.67-0.83 | c-index | 599 (NR) | PCSM | EBRT |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 7 | 0.75 | c-index | 2469 (NR) | DM | 3D-CRT, IMRT |
| Sanpaolo [21] | Survival (Cox, Nomogram presented) | Age, Gleason score, tumor stage, initial PSA, androgen deprivation therapy, pelvic radiotherapy, administered doses, days of radiotherapy, and biologically effective dose | Yes | Internal (bootstrapping) | 0.75 | c-index | 670 (70) | BCF | 3D-CRT |
| Vainshtein [18] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.78 | c-index | 612 (51) | FFM | EBRT |
| Vainshtein [18] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.79 | c-index | 374 (NR) | FFM | EBRT (no ADT) |
| Vainshtein [18] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.80 | c-index | 612 (23) | PCSM | EBRT |
| Vainshtein [18] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.80 | c-index | 153 (NR) | FFM | EBRT with short term Androgen deprivation |
| Zaorsky [65] | Survival model | Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages. | Yes | External validation of AJCC version 7 | 0.81 | c-index | 2469 (NR) | PCSM | 3D-CRT, IMRT |
| Proust-Lima [51] | Joint Model (Latent Class) | Repeat PSA measures | No | External (two separate cohorts n =503 and 615) | 0.82 | Weighted average error of prediction (WAEP) at 1 year; after 3 years 0.0614, 0.0095. | 1268 (190) | Clinical recurrence | EBRT |
| Vainshtein [18] | Risk stratification | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External validation of CAPRA | 0.86 | c-index | 374 (NR) | PCSM | EBRT (no ADT) |
| Yu [63] | Joint modelling | T stage, ln(PSA), Gleason, Age, dose, duration of RT, PSA, slope, HT, Baseline hazards, measurementerrors and tuning parameters. | No, baseline hazards, measurement errors, tuning parameters included | External (prospective on 612 patients from the original cohort) | Not stated | NA | 928 (24) | BCF | EBRT |
| Yu [64] | Survival model (Cox) | Peri-neurial invasion, clinical T stage, Gleason, pre-treatment PSA, radiation dose, ADT | Yes | Not stated | Not stated | NA | 657 (145) | BCF | EBRT |
| Cooperberg [40] | Survival model (Weibull parametric) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External | Not stated | NA | 1143 (NR) | 10 year PCSM | EBRT |
| Cooperberg [39] | Survival model (Cox) | CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer) | Yes | External | Not stated | NA | 1262 (62) | PCSM | EBRT |
| Zumsteg [69] | Survival model (Cox) | Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors | Yes | Not stated | Not stated | NA | 424 (NR) | BFFF | EBRT |
| Zumsteg [69] | Survival Model (Fine and Gray) | Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors | Yes | Not stated | Not stated | NA | 424 (NR) | PCSM | EBRT |
| Zumsteg [69] | Survival model (Cox) | Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors | Yes | Not stated | Not stated | NA | 424 (NR) | LF | EBRT |
| Zumsteg [69] | Survival model (Cox) | Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors | Yes | Not stated | Not stated | NA | 424 (NR) | DM | EBRT |
| Zelefsky [67] | Survival Model (Fine and Gray) | T stage, Gleason, RT dose, pre-RT PSA, Nadir PSA | Yes | Not stated | Not stated | NA | 812 (81) | DM | 3D-CRT, IMRT |
| Zelefsky [67] | Survival Model (Fine and Gray) | T stage, Gleason, RT dose, pre-RT PSA, Nadir PSA | Yes | Not stated | Not stated | NA | 843 (65) | PCSM | 3D-CRT, IMRT |
| Zelefsky [67] | Survival model (Cox) | T stage, Gleason, RT dose, pre-RT PSA, Nadir PSA | Yes | Not stated | Not stated | NA | 769 (246) | BFFF | 3D-CRT, IMRT |
| Thames [59] | Survival model (Cox) | T stage, Gleason Score, ln(initial PSA), PSA indicator interval, non-treatment day ratio, dose, Overall treatment time | No, Institution adjustment and PSA interval are cohort specific | Not stated | Not stated | NA | 3426 (1445) | BCF | 2D or 3D-CRT |
| Taylor [58] | Joint model (longitudinal and survival) | Gleason score, T stage, PSA before treatment, Dose and date of radiation, Serial PSA values after treatment | Yes | External (separate cohort not stated) | Not stated | NA | 3232 (458) | Clinical recurrence (local, regional or distant) | EBRT |
| Murgic [50] | Survival model (Cox) | Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores | No, pelvic RT included | Not stated | Not stated | NA | 590 (NR) | BFFF | EBRT |
| Murgic [50] | Survival model (Cox) | Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores | No, pelvic RT included | Not stated | Not stated | NA | 590 (NR) | FFM | EBRT |
| Murgic [50] | Survival model (Cox) | Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores | Yes, pelvic RT included | Not stated | Not stated | NA | 590 (NR) | PCSM | EBRT |
| Murgic [50] | Survival model (Cox) | Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores | Yes, pelvic RT included | Not stated | Not stated | NA | 590 (NR) | OS | EBRT |
| Spratt [55] | Survival model (Cox) | Age, T-stage, Gleason score, pre-treatment PSA, >50% core involvement, use of ADT, and PSA density | Yes, PSA density can be calculated | Not stated | Not stated | NA | 1002 (NR) | BCF | IMRT |
| Spratt [55] | Survival model (Cox) | Age, T-stage, Gleason score, pre-treatment PSA, >50% core involvement, use of ADT, and PSA density | Yes, PSA density can be calculated | Not stated | Not stated | NA | 1002 (NR) | DMFS | IMRT |
| Spratt [55] | Survival Model (Fine and Gray) | Age, T-stage, Gleason score, pre-treatment PSA, >50% core involvement, use of ADT, and PSA density | Yes, PSA density can be calculated | Not stated | Not stated | NA | 1002 (NR) | PCSM | IMRT |
| Sabolch [53] | Survival model (Cox) | Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index. | No, includes Charlson comorbidity index | Not stated | Not stated | NA | 718 (NR) | BFFF | 3D CT or IMRT |
| Sabolch [53] | Survival model (Cox) | Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index. | No, includes Charlson comorbidity index | Not stated | Not stated | NA | 718 (NR) | Freedom from Metastases | 3D CT or IMRT |
| Sabolch [53] | Survival model (Cox) | Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index. | No, includes Charlson comorbidity index | Not stated | Not stated | NA | 718 (NR) | PCSM | 3D CT or IMRT |
| Sabolch [53] | Survival model (Cox) | Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index. | No, includes Charlson comorbidity index | Not stated | Not stated | NA | 718 (NR) | OS | 3D CT or IMRT |
| Huang [47] | Survival model (Cox) | Gleason score, iPSA, and % positive cores | Yes | Not stated | Not stated | NA | 1056 (176) | BCF | EBRT |
| Huang [47] | Survival Model (Fine and Gray) | Gleason score, iPSA, and % positive cores | Yes | Not stated | Not stated | NA | 1056 (30) | PCSM | EBRT |
| Huang [47] | Survival model (Cox) | Gleason score, iPSA, and % positive cores | Yes | Not stated | Not stated | NA | 1056 (634) | OS | EBRT |
| Feng [28] | Survival model (Cox); also recursive partitioning | age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT | No, includes pelvic RT | Not stated | Not stated | NA | 651 (NR) | FFM | EBRT |
| Feng [28] | Survival model (Cox); also recursive partitioning | age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT | No, includes pelvic RT | Not stated | Not stated | NA | 651 (NR) | PCSM | EBRT |
| Feng [28] | Survival model (Cox); also recursive partitioning | age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT | No, Includes pelvic RT | Not stated | Not stated | NA | 651 (NR) | BFFF | EBRT |
| Feng [28] | Survival model (Cox); also recursive partitioning | age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT | No, includes Pelvic RT | Not stated | Not stated | NA | 651 (NR) | OS | EBRT |
| Engineer [9] | Survival model (Cox) | Age, Tumour stage, Gleason score, PSA, ADT, radiation dose, period of treatment | No, includes period of treatment | Not stated | Not stated | NA | 174 (21) | BFFF | 2D or 3D-CRT |
| Engineer [9] | Survival model (Cox) | Age, Tumour stage, Gleason score, PSA, ADT, radiation dose, period of treatment | No, includes period of treatment | Not stated | Not stated | NA | 174 (98) | Disease free survival | 2D or 3D-CRT |
| Engineer [9] | Survival model (Cox) | Age, Tumour stage, Gleason score, PSA, ADT, radiation dose, period of treatment | No, includes period of treatment | Not stated | Not stated | NA | 174 (124) | OS | 2D or 3D-CRT |
| Denham [44] | Survival model (Cox) | Time to biochemical failure | Yes | Not stated | Not stated | NA | 802 (125) | PCSM | EBRT |
| Denham [44] | Survival model (Cox) | PSA doubling time | No, multiple PSA measures required | Not stated | Not stated | NA | 802 (125) | PCSM | EBRT |
| D’Amico [43] | Survival Model (Fine and Gray) | PSA velocity, biopsy Gleason score, PSA, and clinical stage | No, PSA velocity | Not stated | Not stated | NA | 288 (32) | PCSM | 3D-CRT |
| Slater [54] | Survival model (Cox) | NCCN grouping, percent positive biopsy cores (PPBC), percentage of cancer volume (PCV), maximum involvement of biopsy scores (MIBC) | No, percentage cancer volume | Not stated | Not stated | NA | 398 (NR) | bNED | Proton and photonbeam therapy |
| D’Ambrosio [41] | Survival model (Cox) | Non-treatment day ratio, absolute number of non-treatment days, Gleason, pre-treatment PSA, T stage, radiation dose | No, includes treatment days | Not stated | Not stated | NA | 1796 (NR) | BCF | 3D-CRT, IMRT |
Abbreviations: OS overall survival, RT radiotherapy, BCF bio chemical failure, BFFF bio chemical freedom from failure, PCSM prostate cancer specific mortality, LF local failure, DM distant metastases, DMFS distant metastases-free survival, FFM freedom from metastases, TTBF time to bio chemical failure, STI secondary therapeutic intervention, bNED bio chemical no evidence of disease, 2D-CRT 2D - Conformal radiotherapy; 3D-CRT 3D -Conformal radiotherapy, EBRT external beam radiotherapy, NA not applicable, NR not reported