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Table 3 Prognostic tools relating to external beam radiation therapy

From: An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: a systematic review

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
  1. 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