Prediction models of incontinence and sexual function one year after radical prostatectomy based on data from 20 164 prostate cancer patients
Author:
Sibert Nora TabeaORCID, Kurth Tobias, Breidenbach Clara, Wesselmann Simone, Feick Günther, Carl Ernst-Günter, Dieng Sebastian, Albarghouth Mohamad Hatem, Aziz Atiqullah, Baltes Stefan, Bartolf Elisabeth, Bedke Jens, Blana Andreas, Brock Marko, Conrad Stefan, Darr Christopher, Distler Florian, Drosos Konstantinos, Duwe Gregor, Gaber Amr, Giessing Markus, Harke Nina Natascha, Heidenreich Axel, Hijazi Sameh, Hinkel Andreas, Kaftan Björn Theodor, Kheiderov Shatlyk, Knoll Thomas, Lümmen Gerd, Peters Inga, Polat Bülent, Schrodi Valentin, Stolzenburg Jens-Uwe, Varga Zoltan, von Süßkind-Schwendi Julius, Zugor Vahudin, Kowalski ChristophORCID
Abstract
Background
Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool.
Methods
Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80–20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models.
Results
For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/.
Conclusion
The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.
Funder
Movember Foundation
Publisher
Public Library of Science (PLoS)
Subject
Multidisciplinary
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