{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:45:00Z","timestamp":1785422700904,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Council of Cantonal Hospital in Aarau"},{"id":[{"id":"https:\/\/ror.org\/03tcppy59","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Preoperative side-specific identification of extracapsular extension (ECE) is important for selecting an appropriate nerve-sparing strategy at radical prostatectomy. Patients with multiparametric magnetic resonance imaging (mpMRI)-defined capsular contact represent a clinically challenging subgroup because contact raises concern for ECE but does not uniformly indicate extraprostatic disease. We aimed to develop a side-specific nomogram for individualized ECE prediction and perform preliminary internal validation in this selected population. Materials and Methods: We retrospectively analyzed 323 prostate lobes from 286 patients with biopsy-proven, non-metastatic prostate cancer and mpMRI-defined capsular contact who underwent robot-assisted radical prostatectomy between 2015 and 2021 at a single institution. The dataset was randomly split into training (70%) and testing (30%) cohorts. Three multivariable logistic-regression models were developed and compared. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC-ROC), calibration by intercept and slope, and clinical utility by decision curve analysis. A nomogram was derived from the best-performing model in the internal split-sample comparison. Results: Side-specific ECE was present in 110\/323 lobes (34.1%). Among the candidate models, the forward-selection model showed the most favorable apparent performance, with an AUC-ROC of 0.85 in training and 0.83 in testing, together with good test-set calibration (intercept 0.24; slope 0.97). The final model included a capsular contact length \u226510 mm, percentage tumor involvement in positive biopsy cores, number of positive biopsy cores, and index lesion size. At a 10% predicted risk threshold, 32% of lobes were classified as low risk, with an observed ECE rate of about 5%. Conclusions: We developed a side-specific nomogram tailored to patients with mpMRI-defined capsular contact and performed preliminary internal validation. The model may aid preoperative side-specific risk assessment relevant to nerve-sparing planning, but external validation and assessment of clinical impact are required before clinical adoption.<\/jats:p>","DOI":"10.3390\/cancers18111788","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:57:18Z","timestamp":1780070238000},"page":"1788","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Internal Validation of a Side-Specific Nomogram Integrating mpMRI and Biopsy Features to Guide Nerve-Sparing Decision Making in Prostate Cancer with Capsular Contact"],"prefix":"10.3390","volume":"18","author":[{"given":"Yusuf","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kateryna","family":"Diahovets","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7278-1406","authenticated-orcid":false,"given":"Tician","family":"Schnitzler","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Seiler","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Cornelius","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Zurich, 8032 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Burkhard","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1901-7967","authenticated-orcid":false,"given":"Rainer","family":"Grobholz","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"},{"name":"Medical Faculty, University of Zurich, 8032 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6610-8431","authenticated-orcid":false,"given":"Marco","family":"Cattaneo","sequence":"additional","affiliation":[{"name":"Department of Clinical Research and Statistics, University of Basel, 4003 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital of Bozen (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen-Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livio","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Thun, 3600 Thun, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirmin","family":"Wolfsgruber","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2664-4771","authenticated-orcid":false,"given":"Stephen","family":"Wyler","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"},{"name":"Medical Faculty, University of Basel, 4003 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1563-3543","authenticated-orcid":false,"given":"Lukas","family":"Prause","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8853-4554","authenticated-orcid":false,"given":"Maciej","family":"Kwiatkowski","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"},{"name":"Medical Faculty, University of Basel, 4003 Basel, Switzerland"},{"name":"Department of Urology, Academic Hospital Braunschweig, 38126 Braunschweig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5472-1933","authenticated-orcid":false,"given":"Luca","family":"Afferi","sequence":"additional","affiliation":[{"name":"Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","unstructured":"Cornford, P., Tilki, D., van den Bergh, R.C.N., Eberli, D., De Meerleer, G., De Santis, M., Gillessen, S., Henry, A.M., van Leenders, H.J.L.H., and Oldenburg, J. (2025). EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer 2025, EAU Guidelines Office."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.eururo.2008.09.051","article-title":"Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences","volume":"55","author":"Yossepowitch","year":"2009","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/jnci\/djj190","article-title":"Preoperative Nomogram Predicting the 10-Year Probability of Prostate Cancer Recurrence After Radical Prostatectomy","volume":"98","author":"Stephenson","year":"2006","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/JU.0000000000002205","article-title":"An Algorithm to Personalize Nerve Sparing in Men with Unilateral High-Risk Prostate Cancer","volume":"207","author":"Martini","year":"2022","journal-title":"J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/bju.13573","article-title":"Prediction of pathological stage based on clinical stage, serum prostate-specific antigen, and biopsy Gleason score: Partin Tables in the contemporary era","volume":"119","author":"Tosoian","year":"2016","journal-title":"BJU Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1093\/jnci\/90.10.766","article-title":"A Preoperative Nomogram for Disease Recurrence Following Radical Prostatectomy for Prostate Cancer","volume":"90","author":"Kattan","year":"1998","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.eururo.2015.08.052","article-title":"PI-RADS Prostate Imaging\u2014Reporting and Data System: 2015, Version 2","volume":"69","author":"Weinreb","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.eururo.2019.02.033","article-title":"Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2","volume":"76","author":"Turkbey","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.eururo.2021.07.027","article-title":"Risk Stratification of Patients Candidate to Radical Prostatectomy Based on Clinical and Multiparametric Magnetic Resonance Imaging Parameters: Development and External Validation of Novel Risk Groups","volume":"81","author":"Mazzone","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.eururo.2015.07.029","article-title":"Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis","volume":"70","author":"Hamoen","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00345-023-04720-5","article-title":"Defining the role of multiparametric MRI in predicting prostate cancer extracapsular extension","volume":"42","author":"Sanguedolce","year":"2024","journal-title":"World J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"W73","DOI":"10.2214\/AJR.14.13600","article-title":"Diagnosis of Extracapsular Extension of Prostate Cancer on Prostate MRI: Impact of Second-Opinion Readings by Subspecialized Genitourinary Oncologic Radiologists","volume":"205","author":"Wibmer","year":"2015","journal-title":"Am. J. Roentgenol."},{"key":"ref_13","first-page":"30.e1","article-title":"Tumor contact with prostate capsule on magnetic resonance imaging: A potential biomarker for staging and prognosis","volume":"35","author":"Kongnyuy","year":"2017","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00345-020-03206-y","article-title":"Trends in risk-group distribution and Pentafecta outcomes in patients treated with nerve-sparing, robot-assisted radical prostatectomy: A 10-year low-intermediate volume single-center experience","volume":"39","author":"Afferi","year":"2021","journal-title":"World J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"110228","DOI":"10.1016\/j.ejrad.2022.110228","article-title":"Which one is better for predicting extraprostatic extension on multiparametric MRI: ESUR score, Likert scale, tumor contact length, or EPE grade?","volume":"149","year":"2022","journal-title":"Eur. J. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.euo.2020.08.008","article-title":"Development and External Validation of a Novel Nomogram to Predict Side-specific Extraprostatic Extension in Patients with Prostate Cancer Undergoing Radical Prostatectomy","volume":"5","author":"Soeterik","year":"2022","journal-title":"Eur. Urol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.euros.2021.12.010","article-title":"External Validation of a Prediction Model for Side-specific Extraprostatic Extension of Prostate Cancer at Robot-assisted Radical Prostatectomy","volume":"37","author":"Veerman","year":"2022","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_18","first-page":"291.e9","article-title":"Apparent diffusion coefficient in the evaluation of side-specific extracapsular extension in prostate cancer: Development and external validation of a nomogram of clinical use","volume":"34","author":"Giganti","year":"2016","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1111\/bju.14353","article-title":"Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer","volume":"122","author":"Martini","year":"2018","journal-title":"BJU Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1007\/s00261-023-03924-y","article-title":"MRI-based nomograms and radiomics in presurgical prediction of extraprostatic extension in prostate cancer: A systematic review","volume":"48","author":"Virarkar","year":"2023","journal-title":"Abdom. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.ejca.2011.11.036","article-title":"Radiomics: Extracting more information from medical images using advanced feature analysis","volume":"48","author":"Lambin","year":"2012","journal-title":"Eur. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1148\/radiol.2020191145","article-title":"The Image Biomarker Standardization Initiative: Standardized Quantitative Radiomics for High-Throughput Image-based Phenotyping","volume":"295","author":"Zwanenburg","year":"2020","journal-title":"Radiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1038\/s41391-023-00776-x","article-title":"An updated model for predicting side-specific extraprostatic extension in the era of MRI-targeted biopsy","volume":"27","author":"Martini","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1038\/s41391-023-00738-3","article-title":"External validation of nomograms including MRI features for the prediction of side-specific extraprostatic extension","volume":"27","author":"Heetman","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.euf.2022.09.006","article-title":"External Validation of Models for Prediction of Side-specific Extracapsular Extension in Prostate Cancer Patients Undergoing Radical Prostatectomy","volume":"9","author":"Diamand","year":"2023","journal-title":"Eur. Urol. Focus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1148\/radiol.2018181278","article-title":"A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI","volume":"290","author":"Mehralivand","year":"2019","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Agrotis, G., J\u00e4derling, F., Lakhani, A., Moreira, A.S.L., Kekelidze, M., Rembak-Szynkiewicz, J., Logager, V., Thoeny, H., Villeirs, G., and Woo, S. (2026). ESR Essentials: MRI-based T-staging in prostate cancer\u2014Practice recommendations by the European Society of Urogenital Radiology. Eur. Radiol., advance online publication.","DOI":"10.1007\/s00330-026-12397-8"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1097\/01.pas.0000173646.99337.b1","article-title":"The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma","volume":"29","author":"Epstein","year":"2005","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_29","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."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/11\/1788\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:02:18Z","timestamp":1780070538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/11\/1788"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["cancers18111788"],"URL":"https:\/\/doi.org\/10.3390\/cancers18111788","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]}}}