Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy

Andrew J. Stephenson, Peter T. Scardino, Michael W. Kattan, Thomas M. Pisansky, Kevin M. Slawin, Eric A. Klein, Mitchell S. Anscher, Jeff M. Michalski, Howard M. Sandler, Daniel W. Lin, Jeffrey D. Forman, Michael J. Zelefsky, Larry L. Kestin, Claus G. Roehrborn, Charles N. Catton, Theodore L. DeWeese, Stanley L. Liauw, Richard K. Valicenti, Deborah A. Kuban, Alan Pollack

Research output: Contribution to journalArticle

625 Citations (Scopus)

Abstract

Purpose: An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence. Patients and Methods: Using multivariate Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients. Results: The 6-year progression-free probability was 32% (95% CI, 28% to 35%) overall. Forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P < .001), prostatectomy Gleason grade (P < .001), PSA doubling time (P < .001), surgical margins (P < .001), androgen-deprivation therapy before or during SRT (P < .001), and lymph node metastasis (P = .019). The resultant nomogram was internally validated and had a concordance index of 0.69. Conclusion: Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level.

Original languageEnglish
Pages (from-to)2035-2041
Number of pages7
JournalJournal of Clinical Oncology
Volume25
Issue number15
DOIs
StatePublished - May 20 2007
Externally publishedYes

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Salvage Therapy
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Radiotherapy
Nomograms
Recurrence
Neoplasms
Androgens
Disease Progression
Lymph Nodes
Regression Analysis
Neoplasm Metastasis
Sensitivity and Specificity
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. / Stephenson, Andrew J.; Scardino, Peter T.; Kattan, Michael W.; Pisansky, Thomas M.; Slawin, Kevin M.; Klein, Eric A.; Anscher, Mitchell S.; Michalski, Jeff M.; Sandler, Howard M.; Lin, Daniel W.; Forman, Jeffrey D.; Zelefsky, Michael J.; Kestin, Larry L.; Roehrborn, Claus G.; Catton, Charles N.; DeWeese, Theodore L.; Liauw, Stanley L.; Valicenti, Richard K.; Kuban, Deborah A.; Pollack, Alan.

In: Journal of Clinical Oncology, Vol. 25, No. 15, 20.05.2007, p. 2035-2041.

Research output: Contribution to journalArticle

Stephenson, AJ, Scardino, PT, Kattan, MW, Pisansky, TM, Slawin, KM, Klein, EA, Anscher, MS, Michalski, JM, Sandler, HM, Lin, DW, Forman, JD, Zelefsky, MJ, Kestin, LL, Roehrborn, CG, Catton, CN, DeWeese, TL, Liauw, SL, Valicenti, RK, Kuban, DA & Pollack, A 2007, 'Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy', Journal of Clinical Oncology, vol. 25, no. 15, pp. 2035-2041. https://doi.org/10.1200/JCO.2006.08.9607
Stephenson, Andrew J. ; Scardino, Peter T. ; Kattan, Michael W. ; Pisansky, Thomas M. ; Slawin, Kevin M. ; Klein, Eric A. ; Anscher, Mitchell S. ; Michalski, Jeff M. ; Sandler, Howard M. ; Lin, Daniel W. ; Forman, Jeffrey D. ; Zelefsky, Michael J. ; Kestin, Larry L. ; Roehrborn, Claus G. ; Catton, Charles N. ; DeWeese, Theodore L. ; Liauw, Stanley L. ; Valicenti, Richard K. ; Kuban, Deborah A. ; Pollack, Alan. / Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 15. pp. 2035-2041.
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abstract = "Purpose: An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence. Patients and Methods: Using multivariate Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients. Results: The 6-year progression-free probability was 32{\%} (95{\%} CI, 28{\%} to 35{\%}) overall. Forty-eight percent (95{\%} CI, 40{\%} to 56{\%}) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41{\%} (95{\%} CI, 31{\%} to 51{\%}) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P < .001), prostatectomy Gleason grade (P < .001), PSA doubling time (P < .001), surgical margins (P < .001), androgen-deprivation therapy before or during SRT (P < .001), and lymph node metastasis (P = .019). The resultant nomogram was internally validated and had a concordance index of 0.69. Conclusion: Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level.",
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T1 - Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy

AU - Stephenson, Andrew J.

AU - Scardino, Peter T.

AU - Kattan, Michael W.

AU - Pisansky, Thomas M.

AU - Slawin, Kevin M.

AU - Klein, Eric A.

AU - Anscher, Mitchell S.

AU - Michalski, Jeff M.

AU - Sandler, Howard M.

AU - Lin, Daniel W.

AU - Forman, Jeffrey D.

AU - Zelefsky, Michael J.

AU - Kestin, Larry L.

AU - Roehrborn, Claus G.

AU - Catton, Charles N.

AU - DeWeese, Theodore L.

AU - Liauw, Stanley L.

AU - Valicenti, Richard K.

AU - Kuban, Deborah A.

AU - Pollack, Alan

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N2 - Purpose: An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence. Patients and Methods: Using multivariate Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients. Results: The 6-year progression-free probability was 32% (95% CI, 28% to 35%) overall. Forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P < .001), prostatectomy Gleason grade (P < .001), PSA doubling time (P < .001), surgical margins (P < .001), androgen-deprivation therapy before or during SRT (P < .001), and lymph node metastasis (P = .019). The resultant nomogram was internally validated and had a concordance index of 0.69. Conclusion: Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level.

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