Utilizing predictions of early prostate-specific antigen failure to optimize patient selection for adjuvant systemic therapy trials.
OBJECTIVE
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.


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: < or =.009), PSA level greater than 10 ng/mL (P: < or =.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.


CONCLUSIONS
Patients who are most likely to benefit from effective adjuvant systemic therapy after RP can be identified using readily available clinical and pathologic data.
D'Amico
A V
AV
Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. adamico@jcrt.harvard.edu
Whittington
R
R
Malkowicz
S B
SB
Wu
Y H
YH
Chen
M H
MH
Hurwitz
M
M
Kantoff
P W
PW
Tomaszewski
J E
JE
Renshaw
A A
AA
Wein
A
A
Richie
J P
JP
D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000276:immunology* / Q000517:prevention & control; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000276:immunology / Q000473:pathology* / Q000628:therapy*; D012307:Risk Factors
D017430:Prostate-Specific Antigen