We aimed to investigate whether the performance characteristics of available nomograms predicting lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy (RP) change according to the time elapsed between diagnosis and surgery. We identified 816 patients who underwent RP with extended pelvic lymph node dissection (ePLND) after combined prostate biopsy at 6 referral centers. We plotted the accuracy (ROC-derived area under the curve [AUC]) of each Briganti nomogram according to the time elapsed between biopsy ad RP. We then tested whether discrimination of the nomograms improved after accounting for the time elapsed between biopsy ad RP. The median time between biopsy and RP was 3 months. The LNI rate was 13%. The discrimination of each nomogram decreased with increasing time elapsed between biopsy and surgery, where the AUC of the 2019 Briganti nomogram was 88% vs. 70% for men undergoing surgery <2 vs. >6 months from the biopsy. The addition of the time elapsed between biopsy ad RP improved the accuracy of all available nomograms (P < 0.003), with the Briganti 2019 nomogram showing the highest discrimination. Clinicians should be aware that the discrimination of available nomograms decreases according to the time elapsed between diagnosis and surgery. The indication of ePLND should be carefully evaluated in men below the LNI cut-off who had a diagnosis more than 6 months before RP. This has important implications when considering the longer waiting lists related to the impact of COVID-19 on healthcare systems.
Urologic oncology. 2023 May 15 [Epub ahead of print]
Francesco Pellegrino, Elio Mazzone, Armando Stabile, Jean Baptiste Beauval, Giancarlo Marra, Riccardo Campi, Luca Afferi, Junlong Zhuang, Gabriele Sorce, Giuseppe Rosiello, Francesco Barletta, Simone Scuderi, Hongqian Guo, Paolo Gontero, Andrea Minervini, Guillaume Ploussard, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia
Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: ., Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France., Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy., Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy., Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, People's Republic of China., Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer-Toulouse, Oncopole, Toulouse, France.