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

Stephenson, Andrew J.; Scardino, Peter T.; Eastham, James A.; Bianco, Fernando J.; Dotan, Zohar; Fearn, Paul; Kattan, Michael W.

doi:10.1093/jnci/djj190

Cited by 560 publications

(366 citation statements)

References 27 publications

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“…It is possible that the results would have been different with different grouping of the years of diagnosis, but given the consistently strong trends and low p-values realized, this seems unlikely. The 1998 Kattan preoperative nomogram has recently been updated by Stephenson et al, 19 and the 2006 version incorporates more detailed information on biopsy cores taken and positive. It is quite possible that the 2006 nomogram would better reflect a decline in risk within the low-risk group, and would be more relevant to contemporary patients.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment

et al. 2007

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Purpose-To update national risk trends in prostate cancer with a focus on low-risk tumors, to reexamine trends in primary treatment for low-risk tumors, and to attempt to substratify low-risk patients based on pretreatment clinical data. Materials and Methods-Data were abstracted from the Cancer of the Prostate Strategic UrologicResearch Endeavor (CaPSURE) registry. 10,385 men were diagnosed between 1990 and 2006 with localized disease. Low risk was defined as a prostate-specific antigen (PSA) level ≤10 ng/mL, a Gleason score ≤6, and a clinical T stage ≤2a. Temporal trends were assessed for patient distribution among risk groups and within the low-risk group for individual risk factors, Kattan nomogram prediction, Cancer of the Prostate Risk Assessment (CAPRA) score, and primary treatment. The ability of the CAPRA score to substratify low-risk prostatectomy patients was evaluated with survival analysis.

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Section: Discussionmentioning

confidence: 99%

Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment

et al. 2007

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“…The pre-specified inclusion criteria at the time of diagnostic biopsy were selected to mirror patients that would otherwise be considered for surgery or radiation due to a life expectancy greater than 10 years: age ≤ 75, clinical stage T1-T2a, PSA ≤ 10 ng/ml, ≤ 3 positive cores at diagnostic biopsy, biopsy Gleason score ≤ 6, a restaging biopsy prior to commencing AS to confirm the pathologic findings, and no active treatment for a minimum of six months following the second biopsy. Based on our inclusion criteria, all patients had an estimated 5-year risk of biochemical recurrence following radical prostatectomy of <5% 11 .…”

Section: Methodsmentioning

confidence: 99%

A Multi-Institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer

et al. 2013

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Purpose-For select men with low-risk prostate cancer, active surveillance (AS) is more often being considered a management strategy. In a multicenter retrospective study we evaluated the actuarial rates and predictors of remaining on AS, incidence of cancer progression, and pathologic findings of delayed radical prostatectomy.Methods-A cohort of 262 men from four institutions met the following inclusion criteria: age ≤75, PSA ≤10 ng/ml, clinical stage T1-T2a, biopsy Gleason sum ≤6, ≤3 positive cores at diagnostic biopsy, a repeat biopsy before AS, and no treatment for six months following the repeat biopsy. AS started on the date of the second biopsy. Actuarial rates of remaining on AS were calculated and univariate Cox regression used to assess predictors of discontinuing AS.Results-With a median follow-up of 29 months 43 patients ultimately received active treatment. The two and five-year probabilities of remaining on AS were 91% and 75%, respectively. Patients with cancer on the second biopsy (HR=2.23; 95% CI: 1.23-4.06; p=0.007) and a higher number of cancerous cores from the two biopsies combined (p=0.002) were more likely to undergo treatment. Age, PSA, clinical stage, prostate volume, and number of total biopsy cores sampled were not predictive of outcome. One patient developed skeletal metastases 38 months after starting AS. Of the 43 patients undergoing delayed treatment, 41 (95%) are without disease progression at a median of 23 months following treatment.Conclusions-With a median follow-up of 29 months, AS for select patients appears to be safe and associated with a low risk of systemic progression. Cancer at restaging biopsy and a higher total number of cancerous cores are associated with a lower likelihood of remaining on AS. A restaging biopsy should be strongly considered to finalize eligibility for AS.

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“…As patients with BCR after RP are often subjected to salvage radiation or hormonal therapy, 1 prediction tools have become a part of patient assessment and counseling after RP. Several nomograms have been developed to predict BCR after RP, using either preoperative 2 or postoperative 3,4 variables. These nomograms mainly use preoperative prostate-specific antigen (PSA) and pathological variables as predictors.…”

Section: Introductionmentioning

confidence: 99%

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

Schroeck

Sun

Freedland

et al. 2008

Prostate Cancer Prostatic Dis

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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.

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

Cited by 560 publications

References 27 publications

Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment

Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment

A Multi-Institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer

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

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