The Prognostic PDE4D7 Score in a Diagnostic Biopsy Prostate Cancer Patient Cohort with Longitudinal Biological Outcomes

Figures

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  Figure 1. Kaplan-Meier survival analysis of the time to PSA relapse (endpoint: BCR) or start of any salvage therapy after radical prostatectomy (endpoint: STFS) in the DB patient cohort (n=151). ((a)-(c)) Kaplan-Meier analysis of the biochemical recurrence (BCR) free survival in the patient diagnostic biopsy (DB) cohort of the categorized PDE4D7 score, the CAPRA score categories, and the CAPRA & PDE4D7 score combination model. ((d)-(f)) Kaplan-Meier analysis of postsurgical secondary treatment free survival (STFS) in the patient diagnostic biopsy (DB) cohort of the categorized PDE4D7 score, the CAPRA score categories, and the CAPRA & PDE4D7 score combination model. The CAPRA & PDE4D7 combination model was developed by logistic regression in the RP patient cohort and used as such for testing in the DB patient cohort. Censored patients are indicated by vertical bars. PDE4D7 score categories were defined as PDE4D7 (1-2): PDE4D7 scores (1 to <2); PDE4D7 (2-3): PDE4D7 scores (2 to <3); PDE4D7 (3-4): PDE4D7 scores (3 to <4); PDE4D7 (4-5): PDE4D7 scores (4 to <=5). The CAPRA score categories were defined as CAPRA (1): CAPRA scores 0-2; CAPRA (2): CAPRA scores 3-5; CAPRA (3): CAPRA scores ≥6. The…

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  Figure 2. (a) ROC curve analysis of 5-year biochemical recurrence (BCR) in the DB cohort (n=151) of the CAPRAP score versus the CAPRA & PDE4D7 logistic regression model which was developed on the RP patient cohort with complete 5-year follow-up (n=449). (b) Subcohort ROC curve analysis of the 5-year biochemical recurrence (BCR) of CAPRA & PDE4D7 logistic regression model compared to the CAPRA model alone. In this analysis, only patients with a biopsy Gleason ≥7 were included (n=74).

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  Figure 3. (a) Decision curve analysis in the diagnostic biopsy (DB) patient cohort of the net benefit of four different treatment decision strategies for men at risk of disease recurrence within 5 years after surgery. In total 45 of the 151 investigated patients failed the initial primary treatment of surgery by PSA recurrence (29.8%) within 5 years after intervention. Treatment strategies were tested for their net benefit across indicated threshold probabilities (0.05 step size) to trigger prostate surgery based on the probability of future disease recurrence. The CAPRA scores and the CAPRA & PDE4D7 scores were converted into 5-year BCR probabilities with logistic regression on the RP cohort (n=449 men with completed 5-year follow-up) before estimating net benefit. (b) Net reduction analyses demonstrating in how many patients a resection can be avoided based on the predicted risk of BCR derived from the CAPRA score and CAPRA & PDE4D7 score model, respectively.