This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by D’Amico, A. V. Articles by Richie, J. P. Search for Related Content PubMed PubMed Citation Articles by D’Amico, A. V. Articles by Richie, J. P.

Utilizing Predictions of Early Prostate-Specific Antigen Failure to Optimize Patient Selection for Adjuvant Systemic Therapy Trials

From the Departments of Radiation Oncology, Urology, and Pathology, Brigham and Women’s Hospital; Departments of Radiation Oncology and Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA; and the Departments of Radiation Oncology, Urology, and Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA.

Address reprint requests to Anthony V. D’Amico, MD, PhD, Department of Radiation Therapy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, L-2 Level, Boston, MA 02115; email adamico{at}jcrt.harvard.edu

PURPOSE: Prostate-specific antigen (PSA) failure within 2 years after radical prostatectomy (RP) has been shown to be a clinically significant predictor of distant failure. This study was performed to estimate 2-year PSA failure rates on the basis of readily available clinical and pathologic factors to identify patients for whom effective adjuvant systemic therapy is needed.

PATIENTS AND METHODS: A Cox regression multivariable analysis was used to determine whether the percentage of positive prostate biopsies, PSA level, and the pathologic findings at RP in 1,728 men provided clinically relevant information about PSA outcome after RP. A bootstrapping technique with 2,000 replications was used to provide 95% confidence intervals for the predicted 2-year PSA failure rates, which were determined on the basis of the independent clinical and pathologic predictors of PSA outcome.

RESULTS: The independent predictors of time to PSA failure included a percentage of positive prostate biopsies of greater than 34% (P .009), PSA level greater than 10 ng/mL (P .01), seminal vesicle invasion (P = .02), prostatectomy Gleason score of 8 to 10 (P = .04), and positive surgical margins (P = .0001). Predictions of 2-year PSA failure rates and bootstrap estimates of the 95% confidence intervals were arranged in a tabular format, stratified by independent clinical and pathologic predictors of PSA outcome.

CONCLUSION: Patients who are most likely to benefit from effective adjuvant systemic therapy after RP can be identified using readily available clinical and pathologic data.

This article has been cited by other articles:

				P. J. Bastian, G. S. Palapattu, S. Yegnasubramanian, X. Lin, C. G. Rogers, L. A. Mangold, B. Trock, M. Eisenberger, A. W. Partin, and W. G. Nelson Prognostic Value of Preoperative Serum Cell-Free Circulating DNA in Men with Prostate Cancer Undergoing Radical Prostatectomy Clin. Cancer Res., September 15, 2007; 13(18): 5361 - 5367. [Abstract] [Full Text] [PDF]

				A. J. Stephenson, P. T. Scardino, J. A. Eastham, F. J. Bianco Jr., Z. A. Dotan, P. A. Fearn, and M. W. Kattan Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst, May 17, 2006; 98(10): 715 - 717. [Abstract] [Full Text] [PDF]

				A. K. Lee and A. V. D'Amico Utility of Prostate-Specific Antigen Kinetics in Addition to Clinical Factors in the Selection of Patients for Salvage Local Therapy J. Clin. Oncol., November 10, 2005; 23(32): 8192 - 8197. [Abstract] [Full Text] [PDF]

				P. J. Bastian, G. S. Palapattu, X. Lin, S. Yegnasubramanian, L. A. Mangold, B. Trock, M. A. Eisenberger, A. W. Partin, and W. G. Nelson Preoperative Serum DNA GSTP1 CpG Island Hypermethylation and the Risk of Early Prostate-Specific Antigen Recurrence Following Radical Prostatectomy Clin. Cancer Res., June 1, 2005; 11(11): 4037 - 4043. [Abstract] [Full Text] [PDF]

				A. V. D'Amico, J. W. Moul, P. R. Carroll, L. Sun, D. Lubeck, and M.-H. Chen Surrogate End Point for Prostate Cancer-Specific Mortality After Radical Prostatectomy or Radiation Therapy J Natl Cancer Inst, September 17, 2003; 95(18): 1376 - 1383. [Abstract] [Full Text] [PDF]

				A. V. D'Amico, K. Cote, M. Loffredo, A. A. Renshaw, and D. Schultz Determinants of Prostate Cancer-Specific Survival After Radiation Therapy for Patients With Clinically Localized Prostate Cancer J. Clin. Oncol., December 1, 2002; 20(23): 4567 - 4573. [Abstract] [Full Text] [PDF]

				D.-C. Yu, Y. Chen, J. Dilley, Y. Li, M. Embry, H. Zhang, N. Nguyen, P. Amin, J. Oh, and D. R. Henderson Antitumor Synergy of CV787, a Prostate Cancer-specific Adenovirus, and Paclitaxel and Docetaxel Cancer Res., January 1, 2001; 61(2): 517 - 525. [Abstract] [Full Text]