SS-ECE nomogram: Prediction of Side Specific Extracapsular Extension at Radical Prostatectomy
Preoperative prediction of the probability of side specific extracapsular extension (SS-ECE) is a useful aid for most surgeons performing radical prostatectomy (RP). For less experienced surgeons it might represent the main indication for neurovascular bundle (NVB) excision or preservation. Its importance may be more marginal for very experienced surgeons.

The SS-ECE nomogram was externally validated and was highly accurate in a RALP population. 

The SS-ECE nomogram is recommended in the EAU-guidelines to assess the risk of ECE to support decision making regarding NVB excision during RP. 
Research authors: Thomas Steuber, Markus Graefen, Alexander Haese, Andreas Erbersdobler, Felix K.-H. Chun, Thorsten Schlom, Paul Perrotte, Hartwig Huland, Pierre I. Karakiewicz
Details Formula Study characteristics Files & References
Model author
Model ID
Revision date
MeSH terms
  • Prostatectomy
  • Prostate Cancer
  • Nomogram
  • Prostate Specific Antigen
  • Gleason Score
  • Model type
    Logistic regression (Calculation)
    No Formula defined yet
    Condition Formula

    Additional information

    Between January 1999 and December 2003 we performed a detailed, systematic assessment of biopsy and pathological information in 1,118 patients. These patients had biopsy proven, clinically localized prostate cancer and all underwent RP with or without staging lymphadenectomy (peritoneal lymph node dissection) at our institution. None received neoadjuvant or adjuvant androgen ablation, or radiotherapy. Their clinical and pathological information was converted to an SS format and analyzed as 2,236 prostate lobes.

    Study Population

    Total population size: 1118
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    PSA 0.1 6.6 73.2 ng/mL
    % pos cores/lobe 0 33.3 100 %
    % Ca/lobe 0 3.5 96 %

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Clinical stage T1c 1835
    T2a 225
    T2b 109
    T2c 54
    T3 11
    Gleason sum 0 872
    4 or 5 42
    6 943
    7 (3 + 4) 262
    7 (4 + 3) 87
    8 or 9 29
    SS-ECE No 733
    Yes 385
    SS-ECE nomogram: Prediction of Side Specific Extracapsular Extension at Radical Prostatectomy
    Refer to Intended Use for instructions before use
    Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

    Probability of positive ECE is:

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    Probability of positive ECE is:

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    Outcome stratification

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    Conditional information

    Result interpretation

    Nerve-sparing RP can be performed safely in most men with localised prostate cancer (PCa). Clear contraindications are patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3 PCa, and any Gleason score (GS) > 7 on biopsy.

    This externally validated nomogram predicting side-specific extracapsular extension can help guide decision making.

    Multiparametric MRI might be helpful in selecting a nerve-sparing approach.

    If any doubt remains regarding residual tumour, the surgeon should remove the neurovascular bundle (NVB). Alternatively, the use of intra-operative frozen-section analysis can help guide these decisions. 

    Resource: EAU guideline prostate cancer. 

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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