(Stephenson et al. 2007)
Design: Retrospective case series (prognosis), evidence level: 3
Country: United States, setting: Tertiary care
Inclusion criteria Men from 17 hospitals treated with salvage radiotherapy (SRT) for biochemical failure after radical prostatectomy. Biochemical recurrence was defined as PSA 0.2 ng/ml or more and rising, or a single value of 0.5 ng/ml or higher.
Exclusion criteria Adjuvant hormonal therapy after SRT (before or during SRT was acceptable).
Population number of patients = 1540, mean age = 62 years.
Interventions Salvage radiotherapy (not specified in detail). A nomogram to predict disease progression was developed using the following pre-SRT variables: prostatectomy PSA, Gleason score, SVI, surgical margins, LNI, persistently elevated postoperative PSA, pre-SRT PSA, PSA-DT, neoadjuvant ADT, and radiation dose.
Outcomes Disease progression after SRT, defined as serum PSA of 0.2ng/ml or more above the post SRT nadir followed by another higher value, continued rise in PSA, initiation of systemic therapy or clinical recurrence.
Follow up Median follow-up after the completion of salvage radiotherapy was 53 months (IQR 28 to 81 months).
Results 866/1540 (56%) of the men experienced disease progression after SRT. Six year progression free probability was 32% (95% CI 28% to 35%).
From survival analysis, an estimated 48% (95% CI 40 to 56%) of men who had SRT when their PSA was less than 0.5ng/mL were disease free at 6 years, compared with 40% (95% CI 34 to 46%), 28% (95% CI 20 to 35%) and 18% (95% CI 14 to 22%) for men treated at PSA levels of 0.51 to 1.00, 1.01 to 1.50 and greater than 1.51ng/mL respectively.
Multivariate analysis of prognostic factors for disease progression identified the following significant variables: 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 nomogram for the prediction of six year progression free probability was validated internally using bootstrap resampling. The concordance index (similar to the area under the ROC curve - but for censored outcomes) was 0.69.

From: Chapter 5 –The Management of Relapse After Radical Treatment

Cover of Prostate Cancer
Prostate Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 58.
National Collaborating Centre for Cancer (UK).
Copyright © 2008, National Collaborating Centre for Cancer.

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