Introduction

Prostate cancer progresses slowly, but its therapies often have adverse effects. Informed patient counselling regarding clinical outcomes is therefore important. The objective of this study was to identify all external validations of tools that predict clinical outcomes in prostate cancer patients undergoing radical prostatectomy, and evaluate which are optimum for clinical implementation.

Methods

PubMed and Embase were systematically searched from 2007 to 2016. Search terms related to the inclusion criteria: prostate cancer, clinical outcomes, radical prostatectomy and prognosis. Titles/abstracts were screened and relevant studies were advanced to full-text review. The references of full-texts were reviewed for further studies. The Centre for Evidence-Based Medicine prognostic study tool was used for critical appraisal and the online tool Covidence was used for data extraction.

Results

Seventy-three studies externally validated 41 post- and 13 pre-operative tools for the prediction of biochemical recurrence (BCR), aggressive BCR, metastasis, and prostate cancer specific mortality (PCSM). Recommendations for clinical implementation were made based on accuracy, cohort sizes, number of validations, and consistency. The accuracy of recommended tools ranged from 72-92% and 68-79% amongst the largest validation cohorts for post- and pre-operative tools, respectively. For post-operative prognosis we recommend the CAPRA-S, Stephenson, Kattan, DPC and the Suardi nomograms for the prediction of BCR, the DPC nomogram for aggressive BCR, the CAPRA-S and Eggener nomograms for metastasis, and the Eggener nomogram for PCSM. For pre-operative prognosis we recommend the CAPRA and Stephenson nomograms for BCR, the D&[prime]Amico criteria for aggressive BCR, the CAPRA nomogram for metastasis, and the D&[prime]Amico criteria for PCSM.

Conclusions

We identified all tools that can be used to predict clinical outcomes for prostate cancer patients undergoing radical prostatectomy. While many were inaccurate or not well validated, we recommend the best available tools to help clinicians give patients accurate predictions. Use of these tools should help clinicians deliver accurate, evidence based counselling to patients undergoing radical prostatectomy.

Funding

Movember Foundation