Dr. Stacy McBroom
Dr. John Upshaw
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Defining the Risk of Recurrence in Prostate Cancer

Urology Associates is committed to the fight against prostate cancer. As part of that commitment, we are continually providing educational materials that facilitate discussions between you and your patients about treatment. The following information examines the rates of disease recurrence associated with current treatment standards for prostate cancer. We believe this information may be helpful to you when discussing treatment options with our patients. If our patients understand the risk of disease recurrence following definitive therapy, they may be better prepared to meet the challenges ahead.

Prostate Cancer Recurrence Rates

Prostate cancer is now detected at earlier stages due to heightened awareness and improved screening techniques. Despite definitive therapy, cancer cells may remain and can go undetected for years until they develop into metastatic disease. The risk of recurrence is high, suggesting there is a need to improve treatment approaches. Therefore, it is important to predict pathological stage and risk of disease recurrence early, so that appropriate treatment and/or monitoring can be initiated.

  • Approximately one decade ago, the 10-year clinical recurrence rates in a majority of T1-T2 (N0, M0) patients following radical prostatectomy (RP) and radiotherapy (RT) were reported to be 28% and 33%, respectively.1,2
  • More recently, the 5-year clinical recurrence rates following RP and RT were reported to be up to 7% and 24%, respectively.3
  • The 10-year clinical recurrence rates following RP and RT were reported to be up to 31% and 44%, respectively.3

Evaluating the Utility of Prognosticators in Prostate Cancer

There are several prognostic tools available to assist you in predicting pathological stage and/or risk of recurrence following definitive therapy. Below is information about several of the published tools in a chart format to help you evaluate their utility.

Definitive Therapy Prognostic Tool/Nomogram Design Limitations
Radical prostatectomy

Partin

Predictor variables:preoperative PSA, TNM clinical stage, biopsy Gleason score

Predicted outcome:pathological stage4

Patient number:5079 (T1c-T2c,60%T1c) 4

Recently updated to include more patients4

No neoadjuvant hormonal therapy 4

Single-institution study 4

Limited African-American population (6%) 4

Radical prostatectomy

Kattan

Predictor variables:preoperative PSA, specimen Gleason score,capsular invasion,surgical margin status,seminal vesicle invasion,lymph node status 5

Predicted outcome:7-year disease recurrence 5

Patient number:996 (T1a-T3c, NX,M0,majority of patients T2) 5

Single-institution study 5

All Caucasian population 5

Radical prostatectomy

Center for Prostate Disease Research (CPDR)

Predictor variables:age, race, prostatic acid phosphatase, nuclear grade, preoperative PSA, pathological stage, postoperative Gleason score 6

Predicted outcome:relative risk of recurrence 6

Patient number:378 (only 162 pathologically confined to the prostate) 6

31.8%African-American patients 6

Single-institution study 6

No clinical staging 6

External beam radiation therapy (3D conformal)

Kattan

Predictor variables:clinical stage, biopsy Gleason score,pretreatment PSA,radiation dose,administration of neoadjuvant hormonal therapy 7

Predicted outcome:5-year biochemical risk of recurrence 7

Patient number:1042 (T1c �T3c, NX,M0,majority of patients T2) 7

62.9% did not receive neoadjuvant hormonal therapy 7

Single-institution study 7

Limited African-American population 7

Brachytherapy

Kattan

Predictor variables:pretreatment PSA, clinical stage,biopsy Gleason score, adjuvant external beam radiotherapy 8

Predicted outcome:5-year biochemical risk of recurrence without neoadjuvant hormonal therapy 8

Patient number:920 (T1c �T2b, majority of patients T1c) 8

18% received external beam adjuvant radiation therapy 8

Single-institution study 8

References:

  1. Paulson DF, Moul JW, Walther PJ. Radical prostatectomy for clinical Stage T1-2N0M0 prostatic adenocarcinoma:long-term results. J Urol. 1990;144:1180-1184.
  2. Hanks GE, Asbell S, Krall JM, et al. Outcome for lymph node dissection negative T-1b,T-2 (A-2,B) prostate cancer treated with external beam radiation therapy in RTOG 77-06. Int J Radiat Oncol Biol Phys. 1991;21:1099-1103.
  3. Walsh PC, Retik AB, Vaughan ED, eds. Campbell 's Urology. 7th ed. Philadelphia, Pa: WB Saunders Company; 1998.
  4. Partin AW, Mangold LA, Lamm DM, et al. Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urology. 2001;58:843-848.
  5. Kattan MW, Wheeler TM, Scardino PT. Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol.1999;17:1499-1507.
  6. Bauer JJ, Connelly RR, Seterhenn IA, et al. Biostatistical modeling using traditional preoperative and pathological prognostic variables in the selection of men at high risk for disease recurrence after radical prostatectomy for prostate cancer. J Urol. 1998;159:929-933.
  7. Kattan MW, Zelefsky MJ, Kupelian PA, et al. Pretreatment nomogram for predicting the outcome of three-dimensional conformal radiotherapy in prostate cancer. J Clin Oncol. 2000;18:3352-3359.
  8. Kattan MW, Potters L, Blasko JC, et al. Pretreatment nomogram for predicting freedom from recurrence after permanent prostate brachytherapy in prostate cancer. Urology. 2001;58:393-399.