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Pretreatment Nomogram for Prostate-Specific Antigen Recurrence After Radical Prostatectomy or External-Beam Radiation Therapy for Clinically Localized Prostate Cancer

From the Joint Center for Radiation Therapy, Harvard Medical School, and Department of Pathology, Brigham and Women's Hospital, Boston, MA; Departments of Radiation Oncology, Urology, and Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA; and Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA.

Address reprint requests to Anthony V. D'Amico, MD, PhD, Joint Center for Radiation Therapy, Harvard Medical School, 330 Brookline Ave, 5th floor, Boston, MA 02215; Email adamico{at}jcrt.harvard.edu

PURPOSE: To present nomograms providing estimates of prostate-specific antigen (PSA) failure–free survival after radical prostatectomy (RP) or external-beam radiation therapy (RT) for men diagnosed during the PSA era with clinically localized disease.

PATIENTS AND METHODS: A Cox regression multivariable analysis was used to determine the prognostic significance of the pretreatment PSA level, 1992 American Joint Committee on Cancer (AJCC) clinical stage, and biopsy Gleason score in predicting the time to posttherapy PSA failure in 1,654 men with T1c,2 prostate cancer managed with either RP or RT.

RESULTS: Pretherapy PSA, AJCC clinical stage, and biopsy Gleason score were independent predictors (P < .0001) of time to posttherapy PSA failure in patients managed with either RP or RT. Two-year PSA failure rates derived from the Cox regression model and bootstrap estimates of the 95% confidence intervals are presented in the format of a nomogram stratified by the pretreatment PSA, AJCC clinical stage, biopsy Gleason score, and local treatment modality.

CONCLUSION: Men at high risk (> 50%) for early ( 2 years) PSA failure could be identified on the basis of the type of local therapy received and the clinical information obtained as part of the routine work-up for localized prostate cancer. Selection of these men for trials evaluating adjuvant systemic and improved local therapies may be justified.

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