Alberto Briganti1, R Jeffrey Karnes2, Steven Joniau3, Stephen A Boorjian2, Cesare Cozzarini4, Giorgio Gandaglia5, Wolfgang Hinkelbein6, Karin Haustermans7, Bertrand Tombal8, Shahrokh Shariat9, Maxine Sun10, Pierre I Karakiewicz10, Francesco Montorsi11, Hein Van Poppel3, Thomas Wiegel12. 1. Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. Electronic address: briganti.alberto@hsr.it. 2. Department of Urology, Mayo Clinic, Rochester, MN, USA. 3. University Hospitals Leuven, Department of Urology, Leuven, Belgium. 4. Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy. 5. Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada. 6. Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany. 7. University Hospitals Leuven, Department of Radiotherapy, Leuven, Belgium. 8. Department of Urology, Université Catholique de Louvain, Brussels, Belgium. 9. Department of Urology, Medical University of Vienna, Vienna, Austria. 10. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada. 11. Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. 12. Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
Abstract
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.
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.
Authors: Maria Vinsensia; Peter L Chyoke; Boris Hadaschik; Tim Holland-Letz; Jan Moltz; Klaus Kopka; Isabel Rauscher; Walter Mier; Markus Schwaiger; Uwe Haberkorn; Tobias Mauer; Clemens Kratochwil; Matthias Eiber; Frederik L Giesel Journal: J Nucl Med Date: 2017-06-21 Impact factor: 10.057
Authors: Robert B Den; Kasra Yousefi; Edouard J Trabulsi; Firas Abdollah; Voleak Choeurng; Felix Y Feng; Adam P Dicker; Costas D Lallas; Leonard G Gomella; Elai Davicioni; R Jeffrey Karnes Journal: J Clin Oncol Date: 2015-02-09 Impact factor: 44.544
Authors: A Hervás; A Gómez-Caamaño; M Casaña; A Gómez-Iturriaga; J Pastor; J Jove; J L Mengual; C Gónzalez-San Segundo; J Muñoz Journal: Clin Transl Oncol Date: 2017-06-30 Impact factor: 3.405