New nomogram addresses probability of early disease recurrence post-RP


An international group has developed and validated a new nomogram designed to predict the probability of early biochemical recurrence after radical prostatectomy (RP). Early identification of patients at risk for recurrence may improve prognosis because early institution of adjuvant therapy may reduce the risk of progression.

Walz et al. have analyzed data complied from 2,911 patients who underwent RP for localized prostate cancer between January 1992 and December 2005. Statistical models for biochemical recurrence after RP were used to identify potentially significant predictors of such recurrence, including age, PSA level, postoperative (pathological) Gleason score, surgical margin status, extracapsular extension, seminal vesicle invasion, and lymph node invasion.

Based on the available data, the authors developed a nomogram predicting the probability of biochemical recurrence-free survival within 2 years of RP. Data from 2,875 comparable patients treated at an independent center were then used for external validation.

In both cohorts combined, during the first 2 years post-RP, 639 patients (11 percent)experienced relapse, which accounted for 58.5 percent of all observed biochemical recurrence. In the development cohort, except for age, all the potential predictors for recurrence identified above were shown to be relevant to risk for recurrence. A pathological Gleason score ≥ 7, seminal vesicle invasion, and lymph node invasion were the most powerful predictors of biochemical recurrence. The accuracy of the nomogram predicting biochemical recurrence-free survival within 2 years after RP was 0.82 in the external validation cohort.

Two-thirds of all instances of relapse occur during the first 2 years after RP. The newly developed nomogram appears to be able to identify such patients with considerable accuracy. These patients are potentially likley to benefit the most from adjuvant treatment and/or could be ideal candidates for clincial trials of adjuvant treatment.

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