{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:20:23Z","timestamp":1786980023027,"version":"build-2736575974"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001785","name":"Flinders University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001785","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The risk of treatment-related toxicity is important for patients with localised prostate cancer to consider when deciding between treatment options. We developed a model to predict hospitalisation for radiation-induced genitourinary toxicity based on patient characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The prospective South Australian Prostate Cancer Clinical Outcomes registry was used to identify men with localised prostate cancer who underwent curative intent external beam radiotherapy (EBRT) between 1998 and 2019. Multivariable Cox proportional regression was performed. Model discrimination, calibration, internal validation and utility were assessed using C-statistics and area under ROC, calibration plots, bootstrapping, and decision curve analysis, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 3,243 patients treated with EBRT included, of which 644 (20%) patients had a treated-related admission. In multivariable analysis, diabetes (HR 1.35, 95% CI 1.13\u20131.60,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), smoking (HR 1.78, 95% CI 1.40\u20132.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and bladder outlet obstruction (BOO) without transurethral resection of prostate (TURP) (HR 7.49, 95% CI 6.18\u20139.08\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) followed by BOO with TURP (HR 4.96, 95% CI 4.10\u20135.99\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were strong independent predictors of hospitalisation (censor-adjusted c-statistic\u2009=\u20090.80). The model was well-calibrated (AUC\u2009=\u20090.76). The global proportional hazards were met. In internal validation through bootstrapping, the model was reasonably discriminate at five (AUC 0.75) years after radiotherapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first study to develop a predictive model for genitourinary toxicity requiring hospitalisation amongst men with prostate cancer treated with EBRT. Patients with localised prostate cancer and concurrent BOO may benefit from TURP before EBRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-022-04212-y","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T12:03:36Z","timestamp":1668081816000},"page":"2911-2918","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Predicting post-radiation genitourinary hospital admissions in patients with localised prostate cancer"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4483-1204","authenticated-orcid":false,"given":"Rowan","family":"David","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrunal","family":"Hiwase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2618-3266","authenticated-orcid":false,"given":"Arman A.","family":"Kahokehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7683-2693","authenticated-orcid":false,"given":"David I.","family":"Watson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1834-9131","authenticated-orcid":false,"given":"John","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5038-5859","authenticated-orcid":false,"given":"Michael E.","family":"O\u2018Callaghan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,10]]},"reference":[{"issue":"2","key":"4212_CR1","doi-asserted-by":"publisher","first-page":"63","DOI":"10.14740\/wjon1191","volume":"10","author":"P Rawla","year":"2019","unstructured":"Rawla P (2019) Epidemiology of prostate cancer. World J Oncol 10(2):63\u201389","journal-title":"World J Oncol"},{"issue":"2","key":"4212_CR2","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1002\/cncr.10657","volume":"95","author":"AV D'Amico","year":"2002","unstructured":"D\u2019Amico AV, Whittington R, Malkowicz SB, Cote K, Loffredo M, Schultz D et al (2002) Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 95(2):281\u2013286","journal-title":"Cancer"},{"key":"4212_CR3","doi-asserted-by":"crossref","unstructured":"Heemsbergen WD, Al-Mamgani A, Witte MG, van Herk M, Pos FJ, Lebesque JV. Urinary obstruction in prostate cancer patients from the Dutch trial (68 Gy vs. 78 Gy): relationships with local dose, acute effects, and baseline characteristics. International Journal of Radiation Oncology, Biology, Physics. 2010;78(1):19\u201325.","DOI":"10.1016\/j.ijrobp.2009.07.1680"},{"issue":"1","key":"4212_CR4","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.radonc.2014.02.006","volume":"111","author":"V Carillo","year":"2014","unstructured":"Carillo V, Cozzarini C, Rancati T, Avuzzi B, Botti A, Borca VC et al (2014) Relationships between bladder dose-volume\/surface histograms and acute urinary toxicity after radiotherapy for prostate cancer. Radiother Oncol 111(1):100\u2013105","journal-title":"Radiother Oncol"},{"issue":"1","key":"4212_CR5","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.radonc.2015.06.011","volume":"116","author":"N Yahya","year":"2015","unstructured":"Yahya N, Ebert MA, Bulsara M, Haworth A, Kennedy A, Joseph DJ et al (2015) Dosimetry, clinical factors and medication intake influencing urinary symptoms after prostate radiotherapy: an analysis of data from the RADAR prostate radiotherapy trial. Radiother Oncol 116(1):112\u2013118","journal-title":"Radiother Oncol"},{"issue":"3","key":"4212_CR6","first-page":"743","volume":"32","author":"R Mathieu","year":"2014","unstructured":"Mathieu R, Arango JD, Beckendorf V, Delobel JB, Messai T, Chira C et al (2014) Nomograms to predict late urinary toxicity after prostate cancer radiotherapy. World J Urol 32(3):743\u2013751","journal-title":"World J Urol"},{"key":"4212_CR7","doi-asserted-by":"crossref","unstructured":"Herold DM, Hanlon AL, Hanks GE. Diabetes mellitus: a predictor for late radiation morbidity. International Journal of Radiation Oncology*Biology*Physics. 1999;43(3):475\u20139.","DOI":"10.1016\/S0360-3016(98)00460-X"},{"issue":"1","key":"4212_CR8","first-page":"17","volume":"13","author":"P Mavroidis","year":"2018","unstructured":"Mavroidis P, Pearlstein KA, Dooley J, Sun J, Saripalli S, Das SK et al (2018) Fitting NTCP models to bladder doses and acute urinary symptoms during post-prostatectomy radiotherapy. Radiat 13(1):17","journal-title":"Radiat"},{"issue":"4","key":"4212_CR9","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.ijrobp.2013.03.020","volume":"86","author":"AA Ahmed","year":"2013","unstructured":"Ahmed AA, Egleston B, Alcantara P, Li L, Pollack A, Horwitz EM et al (2013) A novel method for predicting late genitourinary toxicity after prostate radiation therapy and the need for age-based risk-adapted dose constraints. Int J Radiat Oncol Biol Phys 86(4):709\u2013715","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"4212_CR10","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/S1470-2045(13)70606-5","volume":"15","author":"RK Nam","year":"2014","unstructured":"Nam RK, Cheung P, Herschorn S, Saskin R, Su J, Klotz LH et al (2014) Incidence of complications other than urinary incontinence or erectile dysfunction after radical prostatectomy or radiotherapy for prostate cancer: a population-based cohort study. Lancet Oncol 15(2):223\u2013231","journal-title":"Lancet Oncol"},{"issue":"1","key":"4212_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12916-014-0241-z","volume":"13","author":"GS Collins","year":"2015","unstructured":"Collins GS, Reitsma JB, Altman DG, Moons KGM (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement. BMC Med 13(1):1","journal-title":"BMC Med"},{"key":"4212_CR12","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.jmva.2019.02.011","volume":"173","author":"HG Hong","year":"2019","unstructured":"Hong HG, Zheng Q, Li Y (2019) Forward regression for Cox models with high-dimensional covariates. J Multivar Anal 173:268\u2013290","journal-title":"J Multivar Anal"},{"issue":"29","key":"4212_CR13","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1093\/eurheartj\/ehu207","volume":"35","author":"EW Steyerberg","year":"2014","unstructured":"Steyerberg EW, Vergouwe Y (2014) Towards better clinical prediction models: seven steps for development and an ABCD for validation. Eur Heart J 35(29):1925\u20131931","journal-title":"Eur Heart J"},{"issue":"4","key":"4212_CR14","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1214\/08-AOS625","volume":"37","author":"H Zou","year":"2009","unstructured":"Zou H, Zhang HH (2009) On the adaptive elastic-net with a diverging number of parameters. Ann Stat 37(4):1733\u20131751","journal-title":"Ann Stat"},{"issue":"1","key":"4212_CR15","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/10485252.2017.1404598","volume":"30","author":"Y Jung","year":"2018","unstructured":"Jung Y (2018) Multiple predicting K-fold cross-validation for model selection. J Nonparametric Stat 30(1):197\u2013215","journal-title":"J Nonparametric Stat"},{"issue":"15","key":"4212_CR16","doi-asserted-by":"publisher","first-page":"308","DOI":"10.21037\/atm.2018.07.02","volume":"6","author":"Z Zhang","year":"2018","unstructured":"Zhang Z, Rousson V, Lee WC, Ferdynus C, Chen M, Qian X et al (2018) Decision curve analysis: a technical note. Ann Transl Med 6(15):308","journal-title":"Ann Transl Med"},{"key":"4212_CR17","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria2020."},{"issue":"SUPPL 13","key":"4212_CR18","doi-asserted-by":"publisher","first-page":"3135","DOI":"10.1002\/cncr.24354","volume":"115","author":"C Fiorino","year":"2009","unstructured":"Fiorino C, Rancati T, Valdagni R (2009) Predictive models of toxicity in external radiotherapy: dosimetric issues. Cancer 115(SUPPL 13):3135\u20133140","journal-title":"Cancer"},{"issue":"1","key":"4212_CR19","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.radonc.2014.04.005","volume":"112","author":"S De Langhe","year":"2014","unstructured":"De Langhe S, De Meerleer G, De Ruyck K, Ost P, Fonteyne V, De Neve W et al (2014) Integrated models for the prediction of late genitourinary complaints after high-dose intensity modulated radiotherapy for prostate cancer: making informed decisions. Radiother Oncol 112(1):95\u201399","journal-title":"Radiother Oncol"},{"issue":"2","key":"4212_CR20","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.radonc.2015.07.048","volume":"116","author":"C Cozzarini","year":"2015","unstructured":"Cozzarini C, Rancati T, Carillo V, Civardi F, Garibaldi E, Franco P et al (2015) Multi-variable models predicting specific patient-reported acute urinary symptoms after radiotherapy for prostate cancer: results of a cohort study. Radiother Oncol 116(2):185\u2013191","journal-title":"Radiother Oncol"},{"issue":"2","key":"4212_CR21","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.ijrobp.2016.05.017","volume":"96","author":"G Sanguineti","year":"2016","unstructured":"Sanguineti G, Arcidiacono F, Landoni V, Saracino BM, Farneti A, Arcangeli S et al (2016) Macroscopic hematuria after conventional or hypofractionated radiation therapy: results from a prospective phase 3 study. Int J Radiat Oncol Biol Phys 96(2):304\u2013312","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"4212_CR22","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.ijrobp.2011.11.047","volume":"84","author":"MJ Zelefsky","year":"2012","unstructured":"Zelefsky MJ, Kollmeier M, Cox B, Fidaleo A, Sperling D, Pei X et al (2012) Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 84(1):125\u2013129","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"SUPPL. 1","key":"4212_CR23","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.1016\/S0167-8140(15)34062-7","volume":"110","author":"V Carillo","year":"2014","unstructured":"Carillo V, Botti A, Casanova Borca V, Cattari G, Civardi F, Cozzarini C et al (2014) Modelling acute urinary toxicity after radiotherapy for prostate cancer. Radiother Oncol 110(SUPPL. 1):S20\u2013S21","journal-title":"Radiother Oncol"},{"issue":"6","key":"4212_CR24","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.1016\/j.urology.2013.01.047","volume":"81","author":"K Kalakota","year":"2013","unstructured":"Kalakota K, Liauw SL (2013) Toxicity after external beam radiotherapy for prostate cancer: an analysis of late morbidity in men with diabetes mellitus. Urology 81(6):1196\u20131201","journal-title":"Urology"},{"issue":"9","key":"4212_CR25","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.clon.2017.03.006","volume":"29","author":"K Byrne","year":"2017","unstructured":"Byrne K, Hruby G, Kneebone A, Whalley D, Guo L, McCloud P et al (2017) Late genitourinary toxicity outcomes in 300 prostate cancer patients treated with dose-escalated image-guided intensity-modulated radiotherapy. Clin Oncol 29(9):617\u2013625","journal-title":"Clin Oncol"},{"key":"4212_CR26","doi-asserted-by":"crossref","unstructured":"Inokuchi H, Mizowaki T, Norihisa Y, Takayama K, Ikeda I, Nakamura K, et al. Correlation between urinary dose and delayed radiation cystitis after 78 Gy intensity-modulated radiotherapy for high-risk prostate cancer: A 10-year follow-up study of genitourinary toxicity in clinical practice. 2017;6:31\u20136.","DOI":"10.1016\/j.ctro.2017.09.005"},{"issue":"2","key":"4212_CR27","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.radonc.2015.10.003","volume":"117","author":"N Yahya","year":"2015","unstructured":"Yahya N, Ebert MA, Bulsara M, House MJ, Kennedy A, Joseph DJ et al (2015) Urinary symptoms following external beam radiotherapy of the prostate: Dose-symptom correlates with multiple-event and event-count models. Radiother Oncol 117(2):277\u2013282","journal-title":"Radiother Oncol"},{"issue":"11","key":"4212_CR28","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1001\/jama.2011.1333","volume":"306","author":"M Alemozaffar","year":"2011","unstructured":"Alemozaffar M, Regan MM, Cooperberg MR, Wei JT, Michalski JM, Sandler HM et al (2011) Prediction of erectile function following treatment for prostate cancer. JAMA 306(11):1205\u20131214","journal-title":"JAMA"},{"key":"4212_CR29","doi-asserted-by":"crossref","unstructured":"David RV, Kahokehr AA, Lee J, Watson DI, Leung J, O\u2019Callaghan ME. Incidence of genitourinary complications following radiation therapy for localised prostate cancer. World journal of urology. 2022.","DOI":"10.1007\/s00345-022-04124-x"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-022-04212-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-022-04212-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-022-04212-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T09:09:08Z","timestamp":1669799348000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-022-04212-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,10]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["4212"],"URL":"https:\/\/doi.org\/10.1007\/s00345-022-04212-y","relation":{},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,10]]},"assertion":[{"value":"8 September 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 November 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The SA-PCCOC database has been approved by the Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC). Approval to access the database was granted by the SA-PCCOC steering committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}