Proposed prognostic scoring system evaluating risk factors for biochemical recurrence of prostate cancer after salvage radiation therapy

Abstract

ObjectiveTo update a previously proposed prognostic scoring system that predicts risk of biochemical recurrence (BCR) after salvage radiation therapy (SRT) for recurrent prostate cancer when using additional patients and a PSA value of 0.2 ng/mL and rising as the definition of BCR. Patients and MethodsWe included 577 patients who received SRT for a rising PSA after radical prostatectomy in this retrospective cohort study. Clinical, pathological, and SRT characteristics were evaluated for association with BCR using relative risks (RRs) from multivariable Cox regression models. ResultsWith a median follow-up of 5.5 years after SRT, 354 patients (61%) experienced BCR. At 5 years after SRT, 40% of patients were free of BCR. Independent associations with BCR were identified for the PSA level before SRT (RR [doubling]: 1.25, P < 0.001), pathological tumour stage (RR [T3a vs T2] 1.21, P = 0.19; RR [T3b/T4 vs T2] 2.09, P < 0.001; overall P < 0.001), Gleason score (RR [7 vs <7] 1.63, P < 0.001; RR [8-10 vs <7] 2.28, P < 0.001; overall P < 0.001), and surgical margin status (RR [positive vs negative] 0.71, P = 0.003). We combined these four variables to create a prognostic scoring system that predicted BCR risk with a c-index of 0.66. Scores ranged from 0 to 7, and 5-year freedom from BCR for different levels of the score was as follows: Score = 0-1: 66%, Score = 2: 46%, Score = 3: 28%, Score = 4: 19%, and Score = 5-7: 15%. ConclusionWe developed a scoring system that provides an estimation of the risk of BCR after SRT. These findings will be useful for patients and physicians in decision making for radiation therapy in the salvage setting.

GATA2 expression and biochemical recurrence following salvage radiation therapy for relapsing prostate cancer

“…4 These factors have been combined into prediction models by several groups; however, there is a notable proportion of patients in the lower risk groups who still experience relapse and vice versa. 5,6 Interestingly, the results of a recent relatively small study suggest that the Decipher® genomic classifier has the potential to be a strong predictor of SRT outcome; however, validation in larger patient cohorts is needed. 7 Another possibility that has potential to improve treatment decision making is to identify tissue biomarkers present in the initial tumour that are independent prognostic factors for BCR and to incorporate this information into the aforementioned predictive algorithms.…”

An Examination of the Association between FOXA1 Staining Level and Biochemical Recurrence following Salvage Radiation Therapy for Recurrent Prostate Cancer

“…Of these, between 15% and 25% will experience a significant rise in their serum prostate specific antigen level following surgery, indicating a biochemical recurrence (BCR) of their disease [ 1 ]. The only potentially curative treatment option available to men who have experienced BCR of prostate cancer after RP is salvage radiation therapy (SRT); however, the reported success of SRT have ranged from 10% to 65% [ 2 – 10 ]. As such, the ability to accurately identify which men have the highest likelihood of responding to SRT represents a key clinical issue for the field.…”

“…Related to this, a number of studies have been performed that attempt to identify specific characteristics that are associated with risk of BCR after SRT. Several well-replicated risk factors have been established, such as elevated pre-SRT PSA level, more advanced pathological tumor stage, higher Gleason score, negative surgical margin, and shorter pre-SRT PSA doubling time [ 2 – 10 ].…”

“…In an attempt to provide patients with individualized estimates of BCR risk that are tailored to their clinical and pathological characteristics, several large studies have proposed scoring algorithms that combine information from multiple prognostic factors [ 4 – 5 , 10 ]. However, the ability of these algorithms to stratify risk of BCR has considerable room for improvement; for example, a notable proportion of patients in the low BCR risks groups still experience BCR [ 4 – 5 , 8 – 10 ]. Therefore, there is a need to identify other factors that are predictive of BCR after SRT in order to enable better patient selection for SRT.…”

Androgen Deprivation Therapy (ADT), Metabolic Syndrome and Metastatic Prostate Cancer: In Vivo and In Vitro Assessments of Effects of Metformin

“…The limitation of lymph node staging is exemplified in the BCR population after primary treatment. When a patient has developed BCR without metastatic disease on imaging and undergone salvage radiotherapy, the risk of PSA progression is 10%, 50% and 80% for low, intermediate and high-risk groups [26,27,250]. The figures would suggest that there were substantial proportion of patients with micro-metastatic disease in fields outside the pelvis at the time of staging prior to implementing salvage therapy that was not recognized.…”