{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:32:14Z","timestamp":1787895134622,"version":"build-2784847793"},"reference-count":53,"publisher":"BMJ","issue":"6","funder":[{"name":"The Urology Foundation"},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Men diagnosed with non-metastatic prostate cancer require standardised and robust long-term prognostic information to help them decide on management. Most currently-used tools use short-term and surrogate outcomes. We explored the evidence base in the literature on available pre-treatment, prognostic models built around long-term survival and assess the accuracy, generalisability and clinical availability of these models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Systematic literature review, pre-specified and registered on PROSPERO (CRD42018086394).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>MEDLINE, Embase and The Cochrane Library were searched from January 2000 through February 2018, using previously-tested search terms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Eligibility criteria<\/jats:title><jats:p>Inclusion required a multivariable model prognostic model for non-metastatic prostate cancer, using long-term survival data (defined as \u22655 years), which was not treatment-specific and usable at the point of diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data extraction and synthesis<\/jats:title><jats:p>Title, abstract and full-text screening were sequentially performed by three reviewers. Data extraction was performed for items in the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. Individual studies were assessed using the new Prediction model Risk Of Bias ASsessment Tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Database searches yielded 6581 studies after deduplication. Twelve studies were included in the final review. Nine were model development studies using data from over 231 888 men. However, only six of the nine studies included any conservatively managed cases and only three of the nine included treatment as a predictor variable. Every included study had at least one parameter for which there was high risk of bias, with failure to report accuracy, and inadequate reporting of missing data common failings. Three external validation studies were included, reporting two available models: The University of California San Francisco (UCSF) Cancer of the Prostate Risk Assessment score and the Cambridge Prognostic Groups. Neither included treatment effect, and both had potential flaws in design, but represent the most robust and usable prognostic models currently available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Few long-term prognostic models exist to inform decision-making at diagnosis of non-metastatic prostate cancer. Improved models are required to inform management and avoid undertreatment and overtreatment of non-metastatic prostate cancer.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2019-029149","type":"journal-article","created":{"date-parts":[[2019,6,22]],"date-time":"2019-06-22T17:35:19Z","timestamp":1561224919000},"page":"e029149","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Models predicting survival to guide treatment decision-making in newly diagnosed primary non-metastatic prostate cancer: a systematic review"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5636-7088","authenticated-orcid":false,"given":"David","family":"Thurtle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina H","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Berry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Pharoah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent J","family":"Gnanapragasam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,22]]},"reference":[{"key":"2020050713503928000_9.6.e029149.1","unstructured":"Cancer Research UK. Prostate cancer statistics. http:\/\/www.cancerresearchuk.org\/cancer-info\/cancerstats\/types\/prostate\/."},{"key":"2020050713503928000_9.6.e029149.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"2020050713503928000_9.6.e029149.3","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.589"},{"key":"2020050713503928000_9.6.e029149.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606221"},{"key":"2020050713503928000_9.6.e029149.5","doi-asserted-by":"crossref","unstructured":"Greenberg DC , Lophatananon A , Wright KA , et al . Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population. PLoS One 2015;10:e0119494.doi:10.1371\/journal.pone.0119494","DOI":"10.1371\/journal.pone.0119494"},{"key":"2020050713503928000_9.6.e029149.6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.eururo.2015.02.020","article-title":"Changing Trends in Surgical Management of Prostate Cancer: the end of overtreatment?","volume":"68","author":"Huland","year":"2015","journal-title":"Eur Urol"},{"key":"2020050713503928000_9.6.e029149.7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1186\/s12916-015-0405-5","article-title":"Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010","volume":"13","author":"Lloyd","year":"2015","journal-title":"BMC Med"},{"key":"2020050713503928000_9.6.e029149.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.11.969"},{"key":"2020050713503928000_9.6.e029149.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(99)00252-6"},{"key":"2020050713503928000_9.6.e029149.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2010.09692.x"},{"key":"2020050713503928000_9.6.e029149.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000158155.33890.e7"},{"key":"2020050713503928000_9.6.e029149.12","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djj190"},{"key":"2020050713503928000_9.6.e029149.13","doi-asserted-by":"crossref","first-page":"370","DOI":"10.3322\/caac.21339","article-title":"American Joint Committee on Cancer acceptance criteria for inclusion of risk models for individualized prognosis in the practice of precision medicine","volume":"66","author":"Kattan","year":"2016","journal-title":"CA Cancer J Clin"},{"key":"2020050713503928000_9.6.e029149.14","doi-asserted-by":"publisher","DOI":"10.1186\/bcr2464"},{"key":"2020050713503928000_9.6.e029149.15","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00136"},{"key":"2020050713503928000_9.6.e029149.16","doi-asserted-by":"crossref","unstructured":"Moons KG , de Groot JA , Bouwmeester W , et al . Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist. PLoS Med 2014;11:e1001744.doi:10.1371\/journal.pmed.1001744","DOI":"10.1371\/journal.pmed.1001744"},{"key":"2020050713503928000_9.6.e029149.17","unstructured":"Wong SS , Wilczynski NL , Haynes RB , et al . Developing optimal search strategies for detecting sound clinical prediction studies in MEDLINE. AMIA Annu Symp Proc 2003:728\u201332."},{"key":"2020050713503928000_9.6.e029149.18","doi-asserted-by":"publisher","DOI":"10.1136\/jamia.2001.0080391"},{"key":"2020050713503928000_9.6.e029149.19","doi-asserted-by":"crossref","first-page":"51","DOI":"10.7326\/M18-1376","article-title":"PROBAST: a tool to assess the risk of bias and applicability of prediction model studies","volume":"170","author":"Wolff","year":"2019","journal-title":"Ann Intern Med"},{"key":"2020050713503928000_9.6.e029149.20","doi-asserted-by":"crossref","first-page":"W1","DOI":"10.7326\/M18-1377","article-title":"PROBAST: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration","volume":"170","author":"Moons","year":"2019","journal-title":"Ann Intern Med"},{"key":"2020050713503928000_9.6.e029149.21","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-14-14"},{"key":"2020050713503928000_9.6.e029149.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.05.009"},{"key":"2020050713503928000_9.6.e029149.23","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27615"},{"key":"2020050713503928000_9.6.e029149.24","doi-asserted-by":"publisher","DOI":"10.1038\/pcan.2012.21"},{"key":"2020050713503928000_9.6.e029149.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)00018-2"},{"key":"2020050713503928000_9.6.e029149.26","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1007\/s00345-015-1691-4","article-title":"PREDICT: model for prediction of survival in localized prostate cancer","volume":"34","author":"Kerkmeijer","year":"2016","journal-title":"World J Urol"},{"key":"2020050713503928000_9.6.e029149.27","doi-asserted-by":"crossref","unstructured":"Gnanapragasam VJ , Lophatananon A , Wright KA , et al . Improving clinical risk stratification at diagnosis in primary prostate cancer: a prognostic modelling study. PLoS Med 2016;13:e1002063.doi:10.1371\/journal.pmed.1002063","DOI":"10.1371\/journal.pmed.1002063"},{"key":"2020050713503928000_9.6.e029149.28","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000117975.40782.95"},{"key":"2020050713503928000_9.6.e029149.29","doi-asserted-by":"publisher","DOI":"10.1093\/jncimonographs\/lgu022"},{"key":"2020050713503928000_9.6.e029149.30","doi-asserted-by":"publisher","DOI":"10.1093\/jncimonographs\/lgu021"},{"key":"2020050713503928000_9.6.e029149.31","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12916-018-1019-5","article-title":"The Cambridge Prognostic Groups for improved prediction of disease mortality at diagnosis in primary non-metastatic prostate cancer: a validation study","volume":"16","author":"Gnanapragasam","year":"2018","journal-title":"BMC Med"},{"key":"2020050713503928000_9.6.e029149.32","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djp122"},{"key":"2020050713503928000_9.6.e029149.33","doi-asserted-by":"publisher","DOI":"10.2217\/fon.09.121"},{"key":"2020050713503928000_9.6.e029149.34","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23908"},{"key":"2020050713503928000_9.6.e029149.35","first-page":"787","article-title":"Predictive tools for prostate cancer staging, treatment response and outcomes","volume":"65","author":"Green","year":"2012","journal-title":"Arch Esp Urol"},{"key":"2020050713503928000_9.6.e029149.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2010.07.034"},{"key":"2020050713503928000_9.6.e029149.37","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s13014-017-0786-z","article-title":"An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: a systematic review","volume":"12","author":"Raymond","year":"2017","journal-title":"Radiat Oncol"},{"key":"2020050713503928000_9.6.e029149.38","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/S0022-5347(18)30648-7","article-title":"Nomogram predicting 10 year life expectancy after radical prostatectomy or radiation therapy for prostate cancer","volume":"177","author":"Walz","year":"2007","journal-title":"Journal of Urology"},{"key":"2020050713503928000_9.6.e029149.39","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)65964-0"},{"key":"2020050713503928000_9.6.e029149.40","first-page":"556","article-title":"Decision-making tools in prostate cancer: from risk grouping to nomograms","volume":"69","author":"Fontanella","year":"2017","journal-title":"Minerva Urol Nefrol"},{"key":"2020050713503928000_9.6.e029149.41","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.juro.2014.11.082","article-title":"A systematic literature review of life expectancy prediction tools for patients with localized prostate cancer","volume":"193","author":"Kent","year":"2015","journal-title":"J Urol"},{"key":"2020050713503928000_9.6.e029149.42","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6787"},{"key":"2020050713503928000_9.6.e029149.43","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1056\/NEJMoa1801993","article-title":"MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis","volume":"378","author":"Kasivisvanathan","year":"2018","journal-title":"N Engl J Med"},{"key":"2020050713503928000_9.6.e029149.44"},{"key":"2020050713503928000_9.6.e029149.45","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.02767.x"},{"key":"2020050713503928000_9.6.e029149.46","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/bju.13857","article-title":"Predictive value of the 2014 International Society of Urological Pathology grading system for prostate cancer in patients undergoing radical prostatectomy with long-term follow-up","volume":"120","author":"Grogan","year":"2017","journal-title":"BJU Int"},{"key":"2020050713503928000_9.6.e029149.47","first-page":"222","article-title":"Predictive factors in prostate cancer: current concepts from the 1999 College of American Pathologists Conference on Solid Tumor Prognostic Factors and the 1999 World Health Organization Second International Consultation on Prostate Cancer","volume":"17","author":"Bostwick","year":"1999","journal-title":"Semin Urol Oncol"},{"key":"2020050713503928000_9.6.e029149.48","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19920701)70:1<161::AID-CNCR2820700126>3.0.CO;2-5"},{"key":"2020050713503928000_9.6.e029149.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.06.046"},{"key":"2020050713503928000_9.6.e029149.50","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b606"},{"key":"2020050713503928000_9.6.e029149.51","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12911-018-0727-2","article-title":"Meta-analysis of predictive models to assess the clinical validity and utility for patient-centered medical decision making: application to the CAncer of the Prostate Risk Assessment (CAPRA)","volume":"19","author":"Lorent","year":"2019","journal-title":"BMC Med Inform Decis Mak"},{"key":"2020050713503928000_9.6.e029149.52","first-page":"211","article-title":"Novel biomarkers and genomic tests in prostate cancer: a critical analysis","volume":"67","author":"Falzarano","year":"2015","journal-title":"Minerva Urol Nefrol"},{"key":"2020050713503928000_9.6.e029149.53","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.ucl.2017.07.003","article-title":"Whom to treat: postdiagnostic risk assessment with Gleason Score, Risk Models, and Genomic Classifier","volume":"44","author":"Herlemann","year":"2017","journal-title":"Urol Clin North Am"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-029149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,26]],"date-time":"2020-09-26T01:54:56Z","timestamp":1601085296000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-029149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":53,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6,28]]},"published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1136\/bmjopen-2019-029149"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-029149","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}