External validation of a nomogram for the prediction of 10-year life expectancy in candidates for radical prostatectomy

  • Sophie KnipperEmail author
  • David Pröwrock
  • Zhe Tian
  • Hans Heinzer
  • Derya Tilki
  • Pierre Karakiewicz
  • Markus Graefen
Original Article



Accurate life expectancy prediction is essential in decision-making concerning treatment of clinically localized prostate cancer (PCa). Nomogram predictions are more precise and reproducible than clinician’s estimations. The most accurate nomogram addressing 10-year life expectancy in PCa patients has not been externally validated to date. Therefore, we aimed to evaluate the performance of this nomogram in a contemporary external cohort.

Patients and methods

For this, we enrolled all consecutive patients, who underwent radical prostatectomy at a single institution between 2005 and 2007. Age at surgery and Charlson Comorbidity Index (CCI) were assessed. PCa-related deaths and patients under 55 years were excluded as indicated by the nomogram. The prediction of 10-year life expectancy was calculated according to the nomogram and compared to actual survival data. Calibration and discrimination were assessed using calibration plots.


Overall, 1597 patients were evaluated, with a median age of 64 years (range 55–78 years) at surgery and a median follow-up of 134.4 months (range 0.1–161.7 months). Median CCI was 0 (range 0–10). At 10 years, 134 patients (8.4%) had died of other causes than PCa. The nomogram showed moderate discrimination capacities on receiver-operator characteristic analysis (c-index: 0.64). On calibration curves, the nomogram underestimated the actual life expectancy.


The performance accuracy of this prediction model was moderate and underestimated 10-year life expectancy of contemporary PCa patients. In conclusion, prediction of life expectancy remains challenging with a continued need for more precise tools.


Prostate cancer Life expectancy External validation Prediction model Nomogram 



There was no external financial support for this study.

Author contributions

Protocol/project development: MG and SK. Data collection or management: DP and SK. Data analysis: SK and ZT. Manuscript writing/editing: SK, DP, HH, DT, PK, and MG.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

345_2019_2706_MOESM1_ESM.docx (36 kb)
Supplementary file1 (DOCX 35 kb)
345_2019_2706_MOESM2_ESM.docx (17 kb)
Supplementary file2 (DOCX 16 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sophie Knipper
    • 1
    • 2
    Email author
  • David Pröwrock
    • 1
  • Zhe Tian
    • 2
  • Hans Heinzer
    • 1
  • Derya Tilki
    • 1
    • 3
  • Pierre Karakiewicz
    • 2
    • 4
  • Markus Graefen
    • 1
  1. 1.Martini-Klinik Prostate Cancer CenterUniversity Hospital Hamburg-EppendorfHamburgGermany
  2. 2.Division of Urology, Cancer Prognostics and Health Outcomes UnitUniversity of Montreal Health CenterMontrealCanada
  3. 3.Department of UrologyUniversity Hospital Hamburg-EppendorfHamburgGermany
  4. 4.Division of UrologyUniversity of Montréal Hospital Center (CHUM)MontrealCanada

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