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Pretreatment Nomogram That Predicts 5-Year Probability of Metastasis Following Three-Dimensional Conformal Radiation Therapy for Localized Prostate Cancer

Michael W. Kattan, Michael J. Zelefsky, Patrick A. Kupelian, Daniel Cho, Peter T. Scardino, Zvi Fuks, Steven A. Leibel

From the Departments of Urology, Biostatistics, and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, and the Cleveland Clinic, Cleveland, OH.

Address reprint requests to Michael W. Kattan, PhD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 27, New York, NY 10021; e-mail: kattanm{at}mskcc.org.

Purpose: There are several nomograms for the patient considering radiation therapy for clinically localized prostate cancer. Because of the questionable clinical implications of prostate-specific antigen (PSA) recurrence, its use as an end point has been criticized in several of these nomograms. The goal of this study was to create and to externally validate a nomogram for predicting the probability that a patient will develop metastasis within 5 years after three-dimensional conformal radiation therapy (CRT).

Patients and Methods: We conducted a retrospective, nonrandomized analysis of 1,677 patients treated with three-dimensional CRT at Memorial Sloan-Kettering Cancer Center (MSKCC) from 1988 to 2000. Clinical parameters examined were pretreatment PSA level, clinical stage, and biopsy Gleason sum. Patients were followed until their deaths, and the time at which they developed metastasis was noted. A nomogram for predicting the 5-year probability of developing metastasis was constructed from the MSKCC cohort and validated using the Cleveland Clinic series of 1,626 patients.

Results: After three-dimensional CRT, 159 patients developed metastasis. At 5 years, 11% of patients experienced metastasis by cumulative incidence analysis (95% CI, 9% to 13%). A nomogram constructed from the data gathered from these men showed an excellent ability to discriminate among patients in an external validation data set, as shown by a concordance index of 0.81.

Conclusion: A nomogram with reasonable accuracy and discrimination has been constructed and validated using an external data set to predict the probability that a patient will experience metastasis within 5 years after three-dimensional CRT.

Supported in part by a gift from the Leon Lowenstein Foundation.

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