When a man is diagnosed with prostate cancer, the first thought that comes to mind for both him and his family is what that diagnosis ultimately means in terms of prognosis. Will it be something that requires a one-time surgery and close postoperative follow-up with full recovery, a chronic disease that requires long-term surveillance and ultimately more aggressive therapy, or a diagnosis that will shorten the patient's lifespan? The latter is the question that weighs heavily on most patients' minds. For patients who undergo treatment, there are multiple available nomograms to predict their risk of biochemical recurrence, but as this does not mean increased risk of death in all patients, this can be a difficult endpoint for patients to understand. Thus, we sought to determine whether nomograms that were already well-established and in widespread use could be used to predict this more clinically meaningful and easier to understand outcome.1'4 Although our underlying question was broad, for this analysis, we decided to focus on the subset of men who underwent definitive surgical management because of the existence of multiple models that clinicians are already familiar with and that have good performance (as we verified). We fully accept that not all men undergo surgery. Rather, our choice of cohort and models was merely to prove our point, not to suggest that all men should have surgery.
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