BACKGROUND: Early salvage radiotherapy (eSRT) represents the only curative option for prostate cancer patients experiencing biochemical recurrence (BCR) for local recurrence after radical prostatectomy (RP).
OBJECTIVE: To develop and internally validate a novel nomogram predicting BCR after eSRT in patients treated with RP.
DESIGN, SETTING, AND PARTICIPANTS: Using a multi-institutional cohort, 472 node-negative patients who experienced BCR after RP were identified. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at prostate-specific antigen (PSA) ≤0.5 ng/ml.
OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS: BCR after eSRT was defined as two consecutive PSA values ≥0.2 ng/ml. Uni- and multivariable Cox regression models predicting BCR after eSRT were fitted. Regression-based coefficients were used to develop a nomogram predicting the risk of 5-yr BCR after eSRT. The discrimination of the nomogram was quantified with the Harrell concordance index and the calibration plot method. Two hundred bootstrap resamples were used for internal validation.
RESULTS AND LIMITATIONS: Mean follow-up was 58 mo (median: 48 mo). Overall, 5-yr BCR-free survival rate after eSRT was 73.4%. In univariable analyses, pathologic stage, Gleason score, and positive surgical margins were associated with the risk of BCR after eSRT (all p ≤ 0.04). These results were confirmed in multivariable analysis, where all the previously mentioned covariates as well as pre-RT PSA were significantly associated with BCR after eSRT (all p ≤ 0.04). A coefficient-based nomogram demonstrated a bootstrap-corrected discrimination of 0.74. Our study is limited by its retrospective nature and use of BCR as an end point.
CONCLUSIONS: eSRT leads to excellent cancer control in patients with BCR for presumed local failure after RP. We developed the first nomogram to predict outcome after eSRT. Our model facilitates risk stratification and patient counselling regarding the use of secondary therapy for individuals experiencing BCR after RP.
PATIENT SUMMARY: Salvage radiotherapy leads to optimal cancer control in patients who experience recurrence after radical prostatectomy. We developed a novel tool to identify the best candidates for salvage treatment and to allow selection of patients to be considered for additional forms of therapy.
Written by:
Briganti A1, Karnes RJ2, Joniau S3, Boorjian SA2, Cozzarini C4, Gandaglia G5, Hinkelbein W6, Haustermans K7, Tombal B8, Shariat S9, Sun M10, Karakiewicz PI10, Montorsi F11, Van Poppel H3, Wiegel T12 Are you the author?
1Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. Electronic address: .
2Department of Urology, Mayo Clinic, Rochester, MN, USA.
3University Hospitals Leuven, Department of Urology, Leuven, Belgium.
4Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.
5Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada.
6Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.
7University Hospitals Leuven, Department of Radiotherapy, Leuven, Belgium.
8Department of Urology, Université Catholique de Louvain, Brussels, Belgium.
9Department of Urology, Medical University of Vienna, Vienna, Austria.
10Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada.
11Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
12Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
Reference: Eur Urol. 2013 Dec 12. pii: S0302-2838(13)01309-2 (Epub ahead of print)
doi: 10.1016/j.eururo.2013.11.045
PubMed Abstract
PMID: 24345725
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