Stephenson et al developed a nomogram for predicting 6-year progression free survival following radiation therapy in a male with recurrent prostate cancer after radical prostatectomy. This can help identify a patient who may benefit from more aggressive or a novel therapy. The authors are from Cleveland Clinic, Memorial Sloan-Kettering Cancer Center, Mayo Clinic and multiple other cancer centers in the United States and Canada.
Patient selection: Gleason scores 4 to 10
Parameters:
(1) PSA at the time of prostatectomy in ng/mL
(2) Gleason score
(3) seminal vesicle invasion
(4) extracapsular extension
(5) surgical margin
(6) lymph node metastasis
(7) persistently elevated postprostatectomy PSA
(8) preradiation PSA
(9) PSA doubling time
(10) neoadjuvant androgen-deprivation therapy
(11) radiation dose
|
Parameter |
Finding |
Points |
|
Gleason score |
4, 5 or 6 |
0 |
|
|
7 |
18.3 |
|
|
8, 9 or 10 |
44.3 |
|
seminal vesicle invasion |
no |
0 |
|
|
yes |
11.3 |
|
extracapsular extension |
no |
0 |
|
|
yes |
2.1 |
|
surgical margins |
negative |
0 |
|
|
positive |
22 |
|
lymph node metastases |
no |
0 |
|
|
yes |
35 |
|
persistently elevated PSA |
no |
0 |
|
|
yes |
2.1 |
|
neoadjuvant androgen deprivation |
no |
0 |
|
|
yes |
41 |
points for PSA at prostatectomy =
= (-0.47 * (PSA)) + 23.5
|
Preradiation PSA |
Points |
|
0.2 to 1.5 |
(33.15 * (PSA)) - 6.019 |
|
1.5 to 20 |
(1.2216 * (PSA)) + 40.96757 |
|
PSA Doubling Time in months |
Points |
|
0 to 20 |
(0.1711 * ((DT)^2)) - (6.485 * (DT)) + 100.3 |
|
20 to 120 |
(-0.3906 * (DT)) + 46.94 |
|
Radiation Dose |
Points |
|
5000 - 6600 rads |
(-0.02853 * (dose)) + 180 |
|
6000 - 6600 |
(-0.01483 * (dose)) + 97.9 |
|
6600 - 7600 rads |
(0.02159 * (dose)) - 143.4 |
total score =
= SUM(points for all 11 parameters)
|
Total Points |
Probability of 6-Year Progression Free Survival |
|
< 59 |
> 90% |
|
59 to 180 |
(-0.000021 * ((points)^2)) + (0.000958 * (points)) + 0.9176 |
|
180 to 269 |
(0.00004 * ((points)^2)) - (0.02257 * (points)) + 3.16 |
|
> 269 |
< 1% |
Specialty: Hematology Oncology, Surgery, general, Urology
