New nomogram can predict aggressive recurrence after RP

Researchers associated with the Duke Prostate Cancer have re-calibrated an older nomogram (used to predict the likelihood of biochemical recurrence after a radical prostatectomy or RP). The revised nomogram is now capable of predicting not only biochemical recurrence but also the much more clinically significant risk for an aggressive recurrence — in which the post-surgical PSA doubling time (PSADT) is < 9 months.

To develop the re-calibrated nomogram, Schroeck et al. used the Duke Prostate Cancer database of 2,599 men to calculate the PSADT for all patients meeting the standard definintion of biochemical recurrence after surgery who had a minimum of two PSA values, separated by at least 3 months, and taken ≤ 2 years after the initial recurrence. They then validated their revised nomogram using data from 1,695 men treated with RP stored within the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

The results of their study demonstrated the following:

  • The median follow-up for patients with no biochemical recurrence was 56 and 47 months for patients in the Duke Prostate Cancer and SEARCH databases, respectively.
  • In the Duke Prostate Cancer cohort, 645/2,599 patients (25 percent) had a biochemical recurrence and 83/2,599 patients (3.2 percent) had an aggressive recurrence
  • Using the SEARCH validation cohort, 557/1,695 patients (33 percent) had a biochemical recurrence and 71/1,695 patients (4.2 percent) had an aggressive recurrence.
  • In external validation, predictive accuracy for an aggressive biochemical recurrence was high (c = 0.83) and the nomogram showed good calibration.

It would seem likely that this re-calibrated nomogram has significant potential value as a prognostic tool in assessing which patients are at highest risk for aggressive recurrence 0f their cancer after first-line surgery. What is not so clear (at least as yet) is how to best manage these high-risk patients based on this risk. The “New” Prostate Cancer InfoLink would assume that any such patients should at least be getting additional tests to try to identify their risk of local as opposed to systemic recurrence of their disease.

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