Stage migration in localized prostate cancer has no effect on the post‐radical prostatectomy Kattan nomogram

Abstract

Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To investigate the effect of prostate‐specific antigen (PSA) testing on stage migration in an Australian population, and its consequences on the prognostic accuracy of the post‐radical prostatectomy (RP) Kattan nomogram, as in North America widespread PSA testing has resulted in prostate cancer stage migration, questioning the utility of prognostic nomograms in this setting. PATIENTS AND METHODS The study comprised 1008 men who had consecutive RP for localized prostate cancer between 1991 and 2001 at one institution. Two groups were assessed, i.e. those treated in 1991–96 (group 1, the early PSA era), and 1997–2001 (group 2, the contemporary PSA era). Differences in clinicopathological features between the groups were analysed by chi‐squared testing and survival modelling. Individual patient data were entered into the post‐RP Kattan nomogram and the efficacy assessed by receiver‐ operating characteristic curve analysis. RESULTS Patients in group 2 had lower pathological stage disease (P = 0.01) and fewer cancers with Gleason score ≥8 (P < 0.001) than group 1. Multivariate analysis identified preoperative serum PSA level (P < 0.01) and Gleason score (P < 0.01) as strong predictors of biochemical relapse in both groups. In group 2 pathological stage was not significant, but margin involvement became highly significant (P = 0.004). There was no difference in the predictive accuracy of the Kattan nomogram between the groups (P = 0.253). CONCLUSIONS These findings show a downward stage migration towards organ‐confined disease after the introduction of widespread PSA testing in an Australian cohort. Despite this, the Kattan nomogram remains a robust prognostic tool in clinical practice.

An analysis of a multiple biomarker panel to better predict prostate cancer metastasis after radical prostatectomy

“…The Grade Group scores between the discovery and validation cohorts were similar. This is consistent with other literature showing stage migration in the pre‐ and post‐PSA screening era …”

Do prostate cancer nomograms give accurate information when applied to European patients?

“…The accuracy of the nomogram was examined using two groups of patients: one group consisted of an early cohort of patients with localized prostate cancer treated with radical prostatectomy between 1991 and 1996; the second group was treated between 1997 and 2001. No differences were found in the predictive accuracy of the nomogram between the two groups [26].…”

“…However, this should not be of significant concern taking into account the real-life use of nomograms in a heterogeneous clinic population. Thanigasalam et al investigated the consequences of stage migration in the PSA screening era on the prognostic usefulness of Kattan's nomogram [26]. The accuracy of the nomogram was examined using two groups of patients: one group consisted of an early cohort of patients with localized prostate cancer treated with radical prostatectomy between 1991 and 1996; the second group was treated between 1997 and 2001.…”

Nomograms as Predictive Tools for Prostate Cancer Patients Who Had Radical Prostatectomy

“…In addition, a study conducted to determine the effects of lowered PSA at diagnosis with rising PSA screening over the years leads to the clinical stage migration. They found it does not reduce Postoperative Kattan nomogram prediction accuracy [54]. Furthermore, the nomograms were developed for predicting early (2 years) and aggressive (9 -12 months) recurrence after radical prostatectomy.…”