Predicting survival of men with recurrent prostate cancer after radical prostatectomy

Paolo Dell'Oglio, Nazareno Suardi, Stephen A. Boorjian, Nicola Fossati, Giorgio Gandaglia, Zhe Tian, Marco Moschini, Umberto Capitanio, Pierre I. Karakiewicz, Francesco Montorsi, Robert Jeffrey Karnes, Alberto Briganti

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Abstract

Introduction To develop and externally validate a novel nomogram aimed at predicting cancer-specific mortality (CSM) after biochemical recurrence (BCR) among prostate cancer (PCA) patients treated with radical prostatectomy (RP) with or without adjuvant external beam radiotherapy (aRT) and/or hormonal therapy (aHT). Materials & methods The development cohort included 689 consecutive PCA patients treated with RP between 1987 and 2011 with subsequent BCR, defined as two subsequent prostate-specific antigen values >0.2 ng/ml. Multivariable competing-risks regression analyses tested the predictors of CSM after BCR for the purpose of 5-year CSM nomogram development. Validation (2000 bootstrap resamples) was internally tested. External validation was performed into a population of 6734 PCA patients with BCR after treatment with RP at the Mayo Clinic from 1987 to 2011. The predictive accuracy (PA) was quantified using the receiver operating characteristic-derived area under the curve and the calibration plot method. Results The 5-year CSM-free survival rate was 83.6% (confidence interval [CI]: 79.6-87.2). In multivariable analyses, pathologic stage T3b or more (hazard ratio [HR]: 7.42; p = 0.008), pathologic Gleason score 8-10 (HR: 2.19; p = 0.003), lymph node invasion (HR: 3.57; p = 0.001), time to BCR (HR: 0.99; p = 0.03) and age at BCR (HR: 1.04; p = 0.04), were each significantly associated with the risk of CSM after BCR. The bootstrap-corrected PA was 87.4% (bootstrap 95% CI: 82.0-91.7%). External validation of our nomogram showed a good PA at 83.2%. Conclusions We developed and externally validated the first nomogram predicting 5-year CSM applicable to contemporary patients with BCR after RP with or without adjuvant treatment.

Original languageEnglish (US)
Pages (from-to)27-34
Number of pages8
JournalEuropean Journal of Cancer
Volume54
DOIs
StatePublished - Feb 1 2016

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Keywords

  • Adjuvant treatments
  • Biochemical recurrence
  • Nomogram
  • Prostate cancer
  • Prostate cancer death

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Dell'Oglio, P., Suardi, N., Boorjian, S. A., Fossati, N., Gandaglia, G., Tian, Z., Moschini, M., Capitanio, U., Karakiewicz, P. I., Montorsi, F., Karnes, R. J., & Briganti, A. (2016). Predicting survival of men with recurrent prostate cancer after radical prostatectomy. European Journal of Cancer, 54, 27-34. https://doi.org/10.1016/j.ejca.2015.11.004