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However, given adjuvant therapy is usually started a few months after RP and by that time, postoperative PSA levels have reached nadir, it seems reasonable to include postoperative PSA in the decision of whether or not to start secondary treatments. Previously, we showed postoperative PSA nadir was highly correlated with risk of BCR9 and overall mortality.10 Therefore, we sought to explore the effect of including PSA nadir into commonly used models and nomograms on their accuracy to predict BCR after RP among subjects of the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Additionally, we developed a new nomogram incorporating nadir and other well-established predictors of BCR and externally validated it in the Duke Prostate Cancer (DPC) database. After obtaining institutional https://en.wikipedia.org/wiki/Crotamiton review board http://www.selleckchem.com/products/CP-673451.html approval from each institution, data from patients undergoing RP between 1998 and 2008 at four Veteran Affairs Medical Centers (West Los Angeles and Palo Alto, CA; Augusta, GA; and Durham, NC) were combined into the SEARCH database (development cohort).10 The database includes information on patient age at surgery, race, height, weight, clinical stage, cancer grade on diagnostic biopsies, preoperative PSA, surgical specimen pathology (specimen weight, tumor grade, stage and surgical margin status) and follow-up PSA. We restricted our analyses to patients treated between 1998 and 2008 because prior to this time patients were not followed with ultrasensitive PSA assays (sensitivity of 0.01?ng/mL). Data from patients treated at Duke University Medical Center between 1998 and 2007 were abstracted into the DPC Database (validation cohort).11 The database includes similar information to SEARCH; however, patients were followed with non-ultrasensitive PSA (sensitivity of 0.1?ng/mL). External validation on a non-ultrasensitive PSA cohort was chosen given it allows an assessment of the generalizability of our results even when ultrasensitive PSA is unavailable. Patients treated with preoperative hormonal therapy or radiotherapy were excluded from both cohorts. Of 1300 patients in SEARCH, we excluded eight ( http://www.selleckchem.com/products/rxdx-106-cep-40783.html 101 (8%) due to missing follow-up data after nadir and four (