Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

Abstract

We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. BCR was defined as a PSA of 0.2 ng ml À1 or higher at least 30 days after surgery. A nomogram was developed from the Cox model. Predictive accuracy was obtained by calculating bias-corrected Harrell's c and by bootstrap calibration. In multivariate analysis, PSA (hazard ratio 1.39 (95% confidence interval 1.29-1.51)), ECE (1.22 (1.04-1.44)), pG score (1.38 (1.14-1.68), 2.23 (1.76-2.84), 2.69 (2.12-3.40) for pG 3 þ 4, 4 þ 3, 47, respectively), SVI (1.72 (1.40-2.12)), PSM (2.05 (1.73-2.42)), year of surgery (0.65 (0.54-0.77)), African-American race (1.37 (1.13-1.66)), adjuvant ) and prostate weight (0.83 (0.76-0.92)) were identified as independent predictors of BCR (Pp0.018 for all factors). Predictive accuracy of the nomogram was 0.75. Race and prostate weight were independent predictors for BCR after RP. By incorporating these variables, we developed a nomogram, which provides a highly accurate means for estimating risk of BCR after RP.

Do Nomograms Predict Aggressive Recurrence After Radical Prostatectomy More Accurately Than Biochemical Recurrence Alone?

“…This index provides the percentage of correct predictions by the model with values of 0.5 equaling the flip of a coin and 1.0 representing all patients predicted correctly. Predictive accuracy of the following nine models was assessed: a basic clinical model (based on clinical stage, biopsy Gleason score, and logtransformed preoperative PSA) developed in this patient cohort, a basic pathological model (based on pathological stage, prostatectomy Gleason sum, and log-transformed preoperative PSA) developed in this patient cohort, the D'Amico risk classification [3], Kattan's preoperative [4] and postoperative [5] nomograms, a nomogram developed by our team based on a separate patient cohort from the Duke Prostate Center database [6], the CAPRA model [7], which has been previously validated in the SEARCH cohort for predicting BCR [17], a model from the Center for Prostate Disease Research (CPDR) [8], and a model from Johns Hopkins Hospital (JHH) [9]. Thus, none of the previously published models were developed based on data from the SEARCH database.…”

Gleason Score 7 Adenocarcinoma of the Prostate With Lymph Node Metastases: Analysis of 184 Radical Prostatectomy Specimens

“…This result conflicts with prior studies, which concluded that there was an inverse correlation between prostate weight and more-advanced disease. [33][34][35] However, none of the reviewed studies analyzed prostate weight in respect to LN status, and we find our observation novel.…”

Tumor Volume, Tumor Percentage Involvement or Prostate Volume: Which Is Predictive of Psa Recurrence?

“…The size of a normal prostate is 20-30 cc 25,26 and reported medians in the literature set the median for diseased prostate volume around 35-45 cc. 2,12,13,15,24 In our study the median prostate volume was 38.4 cc, with only 25% of men having prostates larger than 50 cc and 10% larger than 64 cc. As a result, our finding that men with prostate volumes less than 35 cc have a 25% increased risk for PSAR compared to men with larger volume prostates provides clinicians with a clinically relevant value by which to assess patients risk for PSAR following RP.…”

“…Previous studies from this team and others showed that men with small PV had higher risk of PSAR. 2,12,14,15 The reason for this remains unknown, however a number of potential explanations exist. It has been suggested that men with smaller prostates may have lower levels of testosterone which has been shown to correlate with more aggressive prostate cancer 22 .…”

“…12,13 Men with smaller prostates have been shown to have higher grade and more advanced disease 14 and men with larger prostates have been shown to have lower rates of PSAR. 15,16 Currently there is no consensus on the utility of TV, TPI and PV in the prediction of PSAR.…”