A Preoperative Nomogram for Disease Recurrence Following Radical Prostatectomy for Prostate Cancer

Abstract

Background: Few published studies have combined clinical prognostic fac tors into risk profiles that can be used to predict the likelihood of recurrence or metastatic progression in patients following treatment of prostate cancer. We developed a nomogram that allows prediction of disease recurrence through use of preoperative clinical factors for patients with clinically localized pros tate cancer who are candidates for treatment with a radical prostatec. Methods: By use of Cox propor tional hazards regression analysis, we modeled the clinical data and disease follow-up for 983 men with clinically localized prostate cancer whom we in tended to treat with a radical prosta tectomy. Clinical data included pre treatment serum prostate-specific antigen levels, biopsy Gleason scores, and clinical stage. Treatment failure was recorded when there was clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ngor greater and rising), or initiation of ad juvant therapy. Validation was peron a separate sample of 168 men, also from our institution. Results: Treatment failure (i.e., cancer recur rence) was noted in 196 of the 983 men, and the patients without failure had a median follow-up of 30 months (range, 1-146 months). The 5-year probability of freedom from failure for the cohort was 73% (95% confidence interval = 69%-76%). The predictions from the nomogram appeared accurate and dis criminating, with a validation sample area under the receiver operating charcurve (i.e., comparison of the predicted probability with the actual outcome) of 0.79. Conclusions: A nomogram has been developed that can be used to predict the 5-year probability of treatment failure among men with clinically localized prostate cancer treated with radical prostatectomy. [J Natl Cancer Inst 1998;90:766-71]