Pretreatment Nomogram Predicting Ten Year Biochemical Outcome Of Three-Dimensional Conformal Radiotherapy And Intensity Modulated Radiotherapy

Main Category: Prostate / Prostate Cancer
Also Included In: Radiology / Nuclear Medicine;  Men's health;  Urology / Nephrology
Article Date: 11 Nov 2007 - 0:00 PDT

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UroToday.com- In the September issue of Urology, Dr. Zelefsky and associates with Dr. Peter Scardino report an update on their nomogram for predicting 10 year outcomes for men treated with 3 dimensional conformal or intensity modulated radiotherapy for prostate cancer (CaP).

The authors point out the benefits of nomograms over risk-stratification to include the use of continuous variables rather than the grouping of variables into categorical groups. Thus, a nomogram is a graphic representation of an algorithm that incorporates multiple risk factors modeled as continuous variables to predict for a particular endpoint. The work updates a report from 2000 on the 5-year biochemical relapse-free survival outcomes for a cohort of men treated with radiotherapy.

From 1988 to 2004, 2,253 patients with CaP were treated at Memorial Sloan Kettering Cancer Center with either 3D-CRT or IMRT for Stage T1-T3 CaP. Regular follow-up was performed and the median follow-up was 7 years. A total of 344 men did not have complete follow-up. A PSA relapse was defined by the Houston definition of absolute nadir plus 2ng/ml. Numerous clinical and pathologic variables to include use of androgen-deprivation were incorporated in the proportional hazards regression model.

Of the 2,253 patients a biochemical recurrence occurred in 578. The 10-year probability for freedom from PSA relapse was 62%. A total of 403 men were relapse free at 7 years, and 53 of these subsequently developed recurrences. Among those men free of disease at 7 years the subsequent 8-year probability of not experiencing a recurrence was 68%. At 10 years 123 patients were free of disease and 10 subsequently developed a relapse. Variables associated with biochemical failure in multivariate model included pretreatment PSA, Gleason score, radiation dose, use of neoadjuvant androgen deprivation, and clinical stage. Overall, application of the Houston definition for failure demonstrated that for patients free of disease at 10 years the risk of subsequent failure was 19%.

Zelefsky MJ, Kattan MW, Fearn P, Fearon BL, Stasi JP, Shippy AM, Scardino PT

Urology. 70(2):283-87, September 2007
doi:10.1016/j.urology.2007.03.060

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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