1
|
Weiner AB, Kakani P, Armstrong AJ, Bossi A, Cornford P, Feng F, Kanabur P, Karnes RJ, Mckay RR, Morgan TM, Schaeffer EM, Shore N, Tree AC, Spratt DE. Risk Stratification of Patients with Recurrence After Primary Treatment for Prostate Cancer: A Systematic Review. Eur Urol 2024; 86:200-210. [PMID: 38782697 DOI: 10.1016/j.eururo.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Biochemical recurrence (BCR) after primary definitive treatment for prostate cancer (PCa) is a heterogeneous disease state. While BCR is associated with worse oncologic outcomes, risk factors that impact outcomes can vary significantly, necessitating avenues for risk stratification. We sought to identify prognostic risk factors at the time of recurrence after primary radical prostatectomy or radiotherapy, and prior to salvage treatment(s), associated with adverse oncologic outcomes. METHODS We performed a systematic review of prospective studies in EMBASE, MEDLINE, and ClinicalTrials.gov (from January 1, 2000 to October 16, 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42023466330). We reviewed the factors associated with oncologic outcomes among patients with BCR after primary definitive treatment. KEY FINDINGS AND LIMITATIONS A total of 37 studies were included (total n = 10 632), 25 after prostatectomy (total n = 9010) and 12 after radiotherapy (total n = 1622). Following recurrence after prostatectomy, factors associated with adverse outcomes include higher pathologic T stage and grade group, negative surgical margins, shorter prostate-specific antigen doubling time (PSADT), higher prostate-specific antigen (PSA) prior to salvage treatment, shorter time to recurrence, the 22-gene tumor RNA signature, and recurrence location on molecular imaging. After recurrence following radiotherapy, factors associated with adverse outcomes include a shorter time to recurrence, and shorter PSADT or higher PSA velocity. Grade group, T stage, and prior short-term hormone therapy (4-6 mo) were not clearly associated with adverse outcomes, although sample size and follow-up were generally limited compared with postprostatectomy data. CONCLUSIONS AND CLINICAL IMPLICATIONS This work highlights the recommendations and level of evidence for risk stratifying patients with PCa recurrence, and can be used as a benchmark for personalizing salvage treatment based on prognostics.
Collapse
Affiliation(s)
- Adam B Weiner
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Preeti Kakani
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrew J Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC, USA
| | - Alberto Bossi
- Amethyst Radiotherapy Group, La Garenne Colombes, France
| | | | - Felix Feng
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA
| | - Pratik Kanabur
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rana R Mckay
- Department of Medicine, Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Todd M Morgan
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Alison C Tree
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
2
|
Falagario UG, Abbadi A, Remmers S, Björnebo L, Bogdanovic D, Martini A, Valdman A, Carrieri G, Menon M, Akre O, Eklund M, Nordström T, Grönberg H, Lantz A, Wiklund P. Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy. JAMA Netw Open 2023; 6:e2332900. [PMID: 37695584 PMCID: PMC10495864 DOI: 10.1001/jamanetworkopen.2023.32900] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/22/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Stratifying patients with biochemical recurrence (BCR) after primary treatment for prostate cancer based on the risk of prostate cancer-specific mortality (PCSM) is essential for determining the need for further testing and treatments. Objective To evaluate the association of BCR after radical prostatectomy or radiotherapy and its current risk stratification with PCSM. Design, Setting, and Participants This population-based cohort study included a total of 16 311 male patients with 10 364 (64%) undergoing radical prostatectomy and 5947 (36%) undergoing radiotherapy with curative intent (cT1-3, cM0) and PSA follow-up in Stockholm, Sweden, between 2003 and 2019. Follow-up for all patients was until death, emigration, or end of the study (ie, December 31, 2018). Data were analyzed between September 2022 and March 2023. Main Outcomes and Measures Primary outcomes of the study were the cumulative incidence of BCR and PCSM. Patients with BCR were stratified in low- and high-risk according to European Association of Urology (EAU) criteria. Exposures Radical prostatectomy or radiotherapy. Results A total of 16 311 patients were included. Median (IQR) age was 64 (59-68) years in the radical prostatectomy cohort (10 364 patients) and 69 (64-73) years in the radiotherapy cohort (5947 patients). Median (IQR) follow-up for survivors was 88 (55-138) months and 89 (53-134) months, respectively. Following radical prostatectomy, the 15-year cumulative incidences of BCR were 16% (95% CI, 15%-18%) for the 4024 patients in the low D'Amico risk group, 30% (95% CI, 27%-32%) for the 5239 patients in the intermediate D'Amico risk group, and 46% (95% CI, 42%-51%) for 1101 patients in the high D'Amico risk group. Following radiotherapy, the 15-year cumulative incidences of BCR were 18% (95% CI, 15%-21%) for the 1230 patients in the low-risk group, 24% (95% CI, 21%-26%) for the 2355 patients in the intermediate-risk group, and 36% (95% CI, 33%-39%) for the 2362 patients in the high-risk group. The 10-year cumulative incidences of PCSM after radical prostatectomy were 4% (95% CI, 2%-6%) for the 1101 patients who developed low-risk EAU-BCR and 9% (95% CI, 5%-13%) for 649 patients who developed high-risk EAU-BCR. After radiotherapy, the 10-year PCSM cumulative incidences were 24% (95% CI, 19%-29%) for the 591 patients in the low-risk EAU-BCR category and 46% (95% CI, 40%-51%) for the 600 patients in the high-risk EAU-BCR category. Conclusions and Relevance These findings suggest the validity of EAU-BCR stratification system. However, while the risk of dying from prostate cancer in low-risk EAU-BCR after radical prostatectomy was very low, patients who developed low-risk EAU-BCR after radiotherapy had a nonnegligible risk of prostate cancer mortality. Improving risk stratification of patients with BCR is pivotal to guide salvage treatment decisions, reduce overtreatment, and limit the number of staging tests in the event of PSA elevations after primary treatment.
Collapse
Affiliation(s)
- Ugo Giovanni Falagario
- Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy
| | - Ahmad Abbadi
- Departments of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Lars Björnebo
- Departments of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Darko Bogdanovic
- Departments of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alberto Martini
- Department of Urology, Division of Surgery, The Univeristy of Texas MD Anderson Cancer Center, Houston
| | - Alexander Valdman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Carrieri
- Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Olof Akre
- Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Departments of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Departments of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grönberg
- Departments of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Lantz
- Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, Stockholm, Sweden
- Departments of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
3
|
Sopeña Sutil R, Vázquez-Martul D, De Pablos-Rodríguez P, Peña Vallejo E, Altez Fernández C, Gómez-Ferrer Lozano A, Téigell Tobar J, Rollón Prieto G, Coy García A, Ramírez Backhaus M, Chantada Abal V, Rodríguez Antolín A. European Association of Urology biochemical recurrence risk groups after radical prostatectomy: External validation and identification of independent risk factors for progression and death. Actas Urol Esp 2023; 47:422-429. [PMID: 36746348 DOI: 10.1016/j.acuroe.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The EAU proposed a progression and death risk classification in patients with biochemical recurrence after radical prostatectomy (PR). OBJECTIVE To validate the EAU BCR-risk classification in our setting and to find factors related to progression and death. MATERIAL AND METHODS Multicenter, retrospective, observational study including 2140 patients underwent RP between 2011 and 2015. Patients with BCR were identified and stratified in low risk (PSA-DT >1yr and pGS <8) or high-risk (PSA-DT ≤1yr or pGS ≥8) grouping. PSA and metastatic free survival (PSA-PFS, MFS), cancer specific survival (CSS) and overall survival (OS) were calculated (Kaplan Meier curves and log-rank test). Independent risk factors were identified (Cox regression). RESULTS 427 patients experienced BCR (32.3% low-risk and 67.7% high-risk). Median PSA-PFS was 135,0 mo (95% CI 129,63-140,94) and 115,0 mo (95% CI 104,02-125,98) (p<0,001), for low and high-risk groups, respectively. There were also significant differences in MFS and OS. The EAU BCR risk grouping was independent factor for PSA-progression (HR 2.55, p 0.009). Time from PR to BCR, was an independent factor for metastasis onset (HR 0.43, 95% CI 0.18-0.99; p 0.044) and death (HR 0.17, 95% CI 0.26.0.96; 23 p 0.048). Differences in MFS (p 0.001) and CSS (p 0.004) were found for <12, ≥12-<36 and ≥36 months from PR to BCR. Others independent factors were early salvage radiotherapy and PSA at BCR. CONCLUSIONS High-risk group is a prognostic factor for biochemical progression, but it has a limited accuracy on MP and death in our setting. The inclusion of other factors could increase its predictive power.
Collapse
Affiliation(s)
- R Sopeña Sutil
- Urology Department, Hospital Universitario 12 de Octubre, Spain.
| | - D Vázquez-Martul
- Urology Department, Complejo Hospitalario Universitario de A Coruña, Spain
| | | | - E Peña Vallejo
- Urology Department, Hospital Universitario 12 de Octubre, Spain
| | - C Altez Fernández
- Urology Department, Complejo Hospitalario Universitario de A Coruña, Spain
| | | | - J Téigell Tobar
- Urology Department, Hospital Universitario 12 de Octubre, Spain
| | - G Rollón Prieto
- Urology Department, Complejo Hospitalario Universitario de A Coruña, Spain
| | - A Coy García
- Urology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - V Chantada Abal
- Urology Department, Complejo Hospitalario Universitario de A Coruña, Spain
| | | |
Collapse
|
4
|
von Eyben R, Hoffmann MA, Soydal C, Virgolini I, Tuncel M, Gauthé M, Kapp DS, von Eyben FE. Pretest PSA and Restaging PSMA PET/CT Predict Survival in Biochemically Recurrent Prostate Cancer. Biomedicines 2023; 11:2333. [PMID: 37760775 PMCID: PMC10525266 DOI: 10.3390/biomedicines11092333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND A biochemical recurrence (BCR) risk model was created based on pretest prostate specific antigen (PSA) and groupings by restaging prostate specific membrane antigen (PSMA) PET/CT. METHODS A cohort of 1216 BCR patients were analyzed for overall survival (OS) according to the PSA threshold and restaging PSMA PET/CT. A Cox regression analysis of OS was carried out to detect significant clinical characteristics. RESULTS In the cohort, 271 patients had a pretest PSA of <0.5 ng/mL and 945 patients had higher PSA values. The restaging PSMA PET/CT was positive for 834 patients and negative for 369. Of 1203 patients, 133 (11%) died, including 19 of the 369 (5%) patients without positive sites on the restaging PSMA PET/CT, 82 of the 711 (12%) with 1-5 positive sites, and 32 of the 123 (26%) with >5 positive sites. In the Cox regression analysis, four variables significantly predicted OS: treatment center, International Society of Urologic Pathology (ISUP) grade, pretest PSA threshold, and the grouping of positive sites on the restaging PSMA PET/CT. CONCLUSIONS The pretest PSA and PSMA PET/CT were important for the OS of the BCR patients. The findings argue for the new BCR risk model and serve as framework for ongoing trials.
Collapse
Affiliation(s)
| | - Manuela Andrea Hoffmann
- Institute for Preventive Medicine of German Armed Forces, 56626 Andernach, Germany
- Department of Nuclear Medicine, University Medical Center, Johannes Gutenberg University in Mainz, 55131 Mainz, Germany
| | - Cigdem Soydal
- Department of Nuclear Medicine, University of Ankara, 0600 Ankara, Turkey;
| | - Irene Virgolini
- Department of Nuclear Medicine, University Hospital in Innsbruck, 6020 Innsbruck, Austria;
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Ankara 06230, Turkey
| | - Mathieu Gauthé
- Department of Nuclear Medicine, Incept, Institute Holland, 38100 Grenoble, France;
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | |
Collapse
|
5
|
Roberts MJ, Chatfield MD, Hruby G, Nandurkar R, Roach P, Watts JA, Cusick T, Kneebone A, Eade T, Ho B, Nguyen A, Tang C, McCarthy M, Francis R, Stricker P, Emmett L. Event-free survival after radical prostatectomy according to prostate-specific membrane antigen-positron emission tomography and European Association of Urology biochemical recurrence risk groups. BJU Int 2022; 130 Suppl 3:32-39. [PMID: 35488182 PMCID: PMC9796546 DOI: 10.1111/bju.15762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 08/04/2022] [Accepted: 04/27/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess European Association of Urology (EAU) risk groups for biochemical recurrence (BCR) of prostate cancer relative to prostate-specific membrane antigen-positron emission tomography (PSMA-PET) status and oncological outcomes. PATIENTS AND METHODS A retrospective analysis of a study that incorporated PSMA-PET for men with BCR after radical prostatectomy (RP) was undertaken. EAU risk groups were considered relative to clinical variables, PSMA-PET findings, and deployment of salvage radiotherapy (SRT). The primary oncological outcome was event-free survival (EFS) and this was analysed relative to clinical and imaging variables. An 'event' occurred if prostate-specific antigen (PSA) level rose >0.2 ng/mL above nadir or additional therapies were introduced. RESULTS A total of 137 patients were included, most of whom had EAU high-risk disease (76%) and/or low PSA levels (80% <0.5 ng/mL) at the time of PSMA-PET. EAU risk group was not associated with regional nodal/distant metastasis on PSMA-PET. Regional nodal/distant metastasis on PSMA PET (compared to negative/local recurrence: hazard ratio [HR] 2.2; P = 0.002) and SRT use (vs no SRT: HR 0.44; P = 0.004) were associated with EFS. EAU high-risk status was not significantly associated with worse EFS (HR 1.7, P = 0.12) compared to EAU low-risk status. Among patients who received SRT, both regional/distant metastasis on PSMA-PET (HR 3.1; P < 0.001) and EAU high-risk status (HR 2.9; P = 0.04) were independently associated with worse EFS, which was driven by patients in the EAU high-risk group with regional/distant metastases (38%; HR 3.1, P = 0.001). CONCLUSIONS In patients with post-RP BCR, PSMA-PET findings and receipt of SRT predicted EFS. In patients receiving SRT, PSMA status combined with EAU risk grouping was most predictive of EFS. These findings suggest that the EAU risk groups could be improved with the addition of PSMA-PET.
Collapse
Affiliation(s)
- Matthew J. Roberts
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQLDAustralia,Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQLDAustralia
| | - Mark D. Chatfield
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQLDAustralia
| | - George Hruby
- Department of Radiation OncologyRoyal North Shore HospitalSydneyNSWAustralia,Genesis Cancer CareSydneyNSWAustralia,Faculty of MedicineUniversity of SydneySydneyNSWAustralia
| | - Rohan Nandurkar
- Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Paul Roach
- Faculty of MedicineUniversity of SydneySydneyNSWAustralia,Department of Nuclear MedicineRoyal North Shore HospitalSydneyNSWAustralia
| | - Jo Anne Watts
- Department of Nuclear Medicine/WA PET ServicesSir Charles Gairdner HospitalPerthWAAustralia,Faculty of Health and Medical ScienceUniversity of Western AustraliaPerthWAAustralia
| | - Thomas Cusick
- Garvan Institute of Medical Research and The Kinghorn Cancer CentreSydneyNSWAustralia
| | - Andrew Kneebone
- Department of Radiation OncologyRoyal North Shore HospitalSydneyNSWAustralia,Genesis Cancer CareSydneyNSWAustralia,Faculty of MedicineUniversity of SydneySydneyNSWAustralia
| | - Thomas Eade
- Department of Radiation OncologyRoyal North Shore HospitalSydneyNSWAustralia,Genesis Cancer CareSydneyNSWAustralia,Faculty of MedicineUniversity of SydneySydneyNSWAustralia
| | - Bao Ho
- Department of Theranostics and Nuclear MedicineSt Vincent's HospitalSydneyNSWAustralia
| | - Andrew Nguyen
- Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia,Department of Theranostics and Nuclear MedicineSt Vincent's HospitalSydneyNSWAustralia
| | - Colin Tang
- Department of Radiation OncologySir Charles Gairdner HospitalPerthWAAustralia
| | - Michael McCarthy
- Department of Nuclear MedicineFiona Stanley HospitalPerthWAAustralia
| | - Roslyn Francis
- Faculty of Health and Medical ScienceUniversity of Western AustraliaPerthWAAustralia,Department of Nuclear MedicineFiona Stanley HospitalPerthWAAustralia
| | - Phillip Stricker
- Faculty of MedicineUniversity of SydneySydneyNSWAustralia,Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia,Department of UrologySt Vincent's HospitalSydneyNSWAustralia
| | - Louise Emmett
- Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia,Department of Theranostics and Nuclear MedicineSt Vincent's HospitalSydneyNSWAustralia
| |
Collapse
|
6
|
Kutluhan MA, Ünal S, Özsoy E, Şahin A, Özayar A, Okulu E, Kayıgil Ö. Evaluation of four pre-operative models for prediction of biochemical recurrence after radical prostatectomy in localised prostate cancer. Int J Clin Pract 2021; 75:e14682. [PMID: 34331823 DOI: 10.1111/ijcp.14682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/17/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Biochemical recurrence (BCR) can be seen in the early or late period after radical prostatectomy (RP). Various models have been developed to predict BCR. OBJECTIVE In our study, we evaluated the accuracy of four pre-operative models (GP score, PRIX, D'Amico risk classification, CAPRA) in predicting BCR after RP in Turkish patients. METHODS Age, preoperative total prostate-specific antigen (PSA) values, clinical stages, total number of cores taken in biopsy, number of positive cores, preoperative biopsy Gleason score (GS), follow-up time and presence of BCR after RP were recorded. BCR was defined as a total PSA value >0.2 ng/dL twice consecutively after RP. Classifications or scoring was performed according to pre-operative models. The 1-, 3- and 5-year BCR-free rates of the patients were determined for each model. Also, the accuracy of four predictive models for predicting 1-, 3- and 5-year BCR was evaluated. RESULTS For all pre-operative models there was a statistically significant difference between risk groups in BCR-free rates at 1-, 3- and 5-year after RP (P < .001). The Harrell's concordance index for 1-year BCR predictions was 0.802, 0.831, 0.773 and 0.745 for the GP score, PRIX, CAPRA and D'Amico, respectively. For 3-year BCR predictions, it was 0.798, 0.791, 0.723 and 0.714 for the GP score, PRIX, CAPRA and D'Amico and respectively. Finally, The Harrell's concordance index for 5-year BCR predictions was 0.778, 0.771, 0.702 and 0.693 for the GP score, PRIX, CAPRA and D'Amico, respectively. CONCLUSION In the prediction of BCR, the accuracy of GP scoring and PRIX seems slightly higher than CAPRA and D'Amico risk classification. Surely our results should be supported by head to head comparisons within other larger cohorts.
Collapse
Affiliation(s)
- Musab Ali Kutluhan
- Department of Urology, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Selman Ünal
- Department of Urology, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | | | - Aytaç Şahin
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Asım Özayar
- Department of Urology, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Emrah Okulu
- Department of Urology, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Önder Kayıgil
- Department of Urology, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| |
Collapse
|