Postoperative Nomogram Predicting the 10-Year Probability of Prostate Cancer Recurrence After Radical Prostatectomy

Abstract

Purpose-A postoperative nomogram for prostate cancer recurrence after radical prostatectomy (RP) has been independently validated as accurate and discriminating. We have updated the nomogram by extending the predictions to 10 years after RP and have enabled the nomogram predictions to be adjusted for the disease-free interval that a patient has maintained after RP.Methods-Cox regression analysis was used to model the clinical information for 1,881 patients who underwent RP for clinically-localized prostate cancer by two high-volume surgeons. The model was externally validated separately on two independent cohorts of 1,782 patients and 1,357 patients, respectively. Disease progression was defined as a rising prostate-specific antigen (PSA) level, clinical progression, radiotherapy more than 12 months postoperatively, or initiation of systemic therapy. Results-The 10-year progression-free probability for the modeling set was 79% (95% CI, 75% to 82%). Significant variables in the multivariable model included PSA (P = .002), primary (P < . 0001) and secondary Gleason grade (P = .0006), extracapsular extension (P < .0001), positive surgical margins (P = .028), seminal vesicle invasion (P < .0001), lymph node involvement (P = . 030), treatment year (P = .008), and adjuvant radiotherapy (P = .046). The concordance index of the nomogram when applied to the independent validation sets was 0.81 and 0.79. Conclusion-We have developed and validated as a robust predictive model an enhanced postoperative nomogram for prostate cancer recurrence after RP. Unique to predictive models, the nomogram predictions can be adjusted for the disease-free interval that a patient has achieved after RP.

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

“…In addition, PGPs at 3 yr and 5 yr after surgery were determined for predefined groupings of CAPRA-S scores that correspond to low risk (CAPRA-S 0-2), intermediate risk (CAPRA-S 3-5), and high risk (CAPRA-S 6-10), as previously described [6]. As a comparison, the PGPs at 3 yr and 5 yr after RP were also calculated for each decile of predicted PGP using the postoperative nomogram developed by Stephenson et al [17]. We chose this nomogram for comparison because it is among the best known and most commonly used validated nomograms using pathologic information from RP, and it was used as a comparator instrument during the original development of CAPRA-S [6].…”

“…Among the 109 published prediction tools [3], only 8 take advantage of pathologic information gained from RP, and very few of these tools have been validated. Among these nomograms, the updated Stephenson postoperative nomogram is well known and commonly referenced and thus was used for comparison with CAPRA-S [17].…”

Outcomes of post‐prostatectomy radiotherapy at a Regional Cancer Centre

“…Retrospective series,30 risk stratification formulae31 and the emergence of more sophisticated imaging techniques32 will continue to guide clinicians in selecting suitable patients for elective PNI 32. The SPPORT trial (NCT00567580) is exploring short‐term ADT with or without the addition PNI and RTOG 0924 (NCT01368588) is solely investigating the addition of PNI in unfavourable intermediate or favourable HRPC patients.…”

Outcomes of extremely low risk prostate cancer following radical prostatectomy

“…The addition of pathological findings from the prostatectomy specimen, including positive surgical margins and extracapsular extension, has been used to construct postoperative nomograms predicting BCR. 5 The management of men with an extremely low risk of BCR who actually develop recurrent disease presents a management dilemma, as neither local nor metastatic recurrence is expected in this cohort. In many of these cases, salvage radiation therapy would be offered if there was a realistic expectation that the intervention would effectively eradicate the disease.…”

“…5 Tumor volume in the surgical specimen has been shown to be an independent predictor of BCR. 6 Therefore, we added tumor volume o5% of the surgical specimen to the above criteria to identify a cohort with extremely low risk for BCR following RP.…”