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:
- Paulson DF, Moul JW, Walther PJ. Radical prostatectomy for
clinical Stage T1-2N0M0 prostatic adenocarcinoma:long-term results. J Urol.
1990;144:1180-1184.
- 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.
- Walsh PC, Retik AB, Vaughan ED, eds. Campbell 's Urology.
7th ed. Philadelphia, Pa: WB Saunders Company; 1998.
- 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.
- Kattan MW, Wheeler TM, Scardino PT. Postoperative nomogram
for disease recurrence after radical prostatectomy for prostate cancer.
J Clin Oncol.1999;17:1499-1507.
- 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.
- 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.
- 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.
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