Some new research has just been published to validate the Stephenson nomogram, which is a tool for predicting whether salvage radiation is likely to succeed based on a host of factors for each individual patient. The good news is that the nomogram basically holds up for predicting mortality and metastasis as well as for predicting biochemical recurrence (which was previously validated). it is a far better predictor of outcome than any individual measure such as gleason or PSA or PSADT or positive surgical margins.
The article can be found here:
www.sciencedirect.com/science/article/pii/S1879850014000502There is an online calculator for the nomogram at MSKCC. You can put in your data and see your odds. This is a great tool for anyone who is considering Salvage radation, with or without ADT.
nomograms.mskcc.org/Prostate/SalvageRadiationTherapy.aspxMethods and materialsFrom an institutional cohort of 575 patients treated with SRT between 1986 and 2010, the Stephenson nomogram variables were retrospectively collected and available for 179 patients. The prognostic impact of the Stephenson nomogram on 6-year freedom from biochemical failure (FFBF), freedom from mets (FFM), and prostate cancer specific survival (PCSS) was assessed on univariate and multivariate analysis using Kaplan-Meier and Cox proportional hazards models. The prognostic utility of the Stephenson nomogram was compared with individual pretreatment, treatment, and clinical characteristics using concordance indices.
ResultsIn the 179 patients with all available nomogram variables, median follow-up was 85.0 months (interquartile range [IQR], 53-113) and 6-year FFBF, FFM, and PCSS were 38% (95% confidence interval [CI], 30-46), 79% (95% CI, 73-85), and 96% (95% CI, 92-100), respectively. Univariate analysis, demonstrated that the Stephenson nomogram, as a continuous variable and as a risk stratified group, was prognostic of FFBF (both, P < .0001), FFM (both, P < .0001), and PCSS (both, P ≤ .0005). When analyzing individual Stephenson nomogram variables, multivariate analysis revealed that positive surgical margins (P = .02; hazard ratio [HR], 0.4; 95% CI, 0.2-0.8) and pre-RT PSA (P = .0001; HR, 1.6; 95% CI, 1.3-2.0) were prognostic for FFM, while pre-RT PSA (P = .03; HR, 1.2; 95% CI, 1.0-1.4) was the only prognostic variable for PCSS. Concordance indices revealed the Stephenson nomogram to have superior prognostic capability for biochemical failure (0.71), distant metastasis (0.75), and prostate cancer–specific mortality (0.75) when compared with individual variables (BF all ≤0.65, DM all ≤0.67, PCSM all ≤0.71).
ConclusionsFor patients treated with SRT for a rising PSA postprostatectomy, the Stephenson nomogram is an appropriate prognostic tool for estimating the response to treatment; however, there remains a need for improvement in current and future nomograms.
Post Edited (proscapt) : 11/5/2014 2:27:54 AM (GMT-7)