Predicting the Risk of Pelvic Node Involvement in Men With Prostate Cancer in the Contemporary Era: Change You Can Believe?: In Regard to Yu, et al. (Int J Radiat Oncol Biol Phys in Press)

Hayes, Maggie; Roach, Mack

doi:10.1016/j.ijrobp.2010.11.008

Cited by 2 publications

(1 citation statement)

References 10 publications

(12 reference statements)

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“…Nonetheless, there is evidence that the Roach formula may overestimate the risk of nodal metastasis by 2.5 to 4.5 fold. [4][5][6] Some high-risk patients might be overtreated with WPRT. The treatment outcome in high-risk patients is diverse.…”

Section: Introductionmentioning

confidence: 99%

Using the Roach Formula to Stratify Patients with Localised Prostate Cancer Treated with Intensity-modulated Radiotherapy

Chan¹,

Lam²,

Lee³

et al. 2017

Hong Kong J Radiol

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Objectives: The Roach formula can be used to calculate the risk of pelvic lymph node involvement in patients with prostate cancer. This study aimed to use the Roach formula to further differentiate high-risk patients at risk of treatment failure after intensity-modulated radiotherapy (IMRT), and to identify factors associated with biochemical failure-free survival (bFFS). Methods: Records of consecutive patients with biopsy-proven localised prostate cancer (T1-4 N0M0) who underwent prostate-only IMRT between February 2006 and August 2011 were retrospectively reviewed. Neoadjuvant and concomitant androgen deprivation therapy (ADT) was given to intermediate-and high-risk patients, whereas adjuvant ADT was given to high-risk patients for 2 to 3 years if they could afford this selffinanced item. Patients were divided into three groups of lymph node involvement based on the Roach formula (≤15%, >15-35%, and >35% risk) and their bFFS were compared. Factors associated with bFFS were identified using univariate and multivariate analyses. Results: The median follow-up duration of 144 patients was 55.8 months. According to the National Institute for Health and Care Excellence classification, 6%, 30%, and 64% of patients were stratified as low, intermediate, and high risk, respectively. According to the Roach formula, 35%, 28%, and 37% of patients were stratified as low, (≤15%), intermediate (>15-35%), and high (>35%) risk of lymph node involvement, respectively. Biochemical failure occurred in 23 patients. The median bFFS was 48.5 months. The 5-year bFFS in the three groups of ≤15%, >15-35%, and >35% risk of lymph node involvement based on the Roach formula were 100%, 87.7%, and 75.4%, respectively (p = 0.003). In multivariate analysis, significant factors associated with better bFFS were patient age of >75 years, pretreatment serum prostate-specific antigen (PSA) of ≤20 ng/ml, undetectable serum PSA after IMRT, and longer duration of adjuvant ADT. Conclusion: The Roach formula can further differentiate patients at higher risk (>15-35% and >35%) of lymph node involvement to receive more intensified IMRT and closer monitoring to improve their bFFS.

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Section: Introductionmentioning

confidence: 99%

Using the Roach Formula to Stratify Patients with Localised Prostate Cancer Treated with Intensity-modulated Radiotherapy

Chan¹,

Lam²,

Lee³

et al. 2017

Hong Kong J Radiol

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The Roach Equation: Value of Old Clinical Tools in the Era of New Molecular Imaging

Roach

2020

J Nucl Med

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Koerber et al. present a single-institution retrospective analysis of the incidence of nodal involvement in 280 men with newly diagnosed intermediate-and (mostly) high-risk prostate cancer who underwent prostate-specific membrane antigen (PSMA) PET/CT as a part of primary staging. These diagnoses were pathologically validated by subsequent lymphadenectomy, and the investigators compared the observed incidence of lymph node involvement (LNI) with the incidence predicted by the Roach equation (1) by comparing the sensitivity and specificity. The bottom line was that the results appeared to be virtually identical. However, as usual, things are not quite that simple. The Roach equation, first derived in the early 1990s, uses a simple equation derived from the Partin nomogram to estimate the risk of LNI in prostate cancer, as follows: LNI risk (%) 5 2/3 • PSA [(Gleason score 2 6) • 10] (2,3). This was validated in a crossinstitutional study of nearly 300 patients between 1987 and 1991, and subsequently this equation has been used in several major randomized clinical trials including Radiation Therapy Oncology Group 94-13 (4) and 09-24 to evaluate the role of elective pelvic nodal irradiation in the definitive management of patients with prostate cancer. This evaluation is important because some studies suggest that prophylactic whole-pelvis radiotherapy may decrease treatment failure rates and improve biochemical-relapse-free survival (4,5), though not necessarily disease-free or overall survival (6). However, whether there is a survival benefit added by elective pelvic nodal irradiation awaits the now fully accrued phase III Radiation Therapy Oncology Group 09-24 trial, which enrolled over 2,500 patients with the goal of providing a definitive answer as to the degree of clinical benefit and toxicity of elective whole-pelvis radiotherapy in men with intermediate-risk and high-risk prostate cancer. However, the accuracy and clinical value of the Roach equation has been called into question. Some studies, including several studies using institutional data and data from large cohorts such as the Surveillance, Epidemiology, and End Results database, have reported that the Roach equation overestimates the risk of LNI (based on nodal findings at the time of prostatectomy) (7,8). This

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Predicting the Risk of Pelvic Node Involvement in Men With Prostate Cancer in the Contemporary Era: Change You Can Believe?: In Regard to Yu, et al. (Int J Radiat Oncol Biol Phys in Press)

Cited by 2 publications

References 10 publications

Using the Roach Formula to Stratify Patients with Localised Prostate Cancer Treated with Intensity-modulated Radiotherapy

Using the Roach Formula to Stratify Patients with Localised Prostate Cancer Treated with Intensity-modulated Radiotherapy

The Roach Equation: Value of Old Clinical Tools in the Era of New Molecular Imaging

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