title: Contemporary identification of patients at high risk of early prostate cancer recurrence after radical retropubic prostatectomy.
abstract: OBJECTIVE
  To develop a model that will identify a contemporary cohort of patients at high risk of early prostate cancer recurrence (greater than 50% at 36 months) after radical retropubic prostatectomy for clinically localized disease. Data from this model will provide important information for patient selection and the design of prospective randomized trials of adjuvant therapies.
  
  
  METHODS
  Proportional hazards regression analysis was applied to two patient cohorts to develop and cross-validate a multifactorial predictive model to identify men with the highest risk of early prostate cancer recurrence. The model and validation cohorts contained 904 and 901 men, respectively, who underwent radical retropubic prostatectomy at Johns Hopkins Hospital. This model was then externally validated using a cohort of patients from the Mayo Clinic.
  
  
  RESULTS
  A model for weighted risk of recurrence was developed: R(W)'=lymph node involvement (0/1)x1.43+surgical margin status (0/1)x1.15+modified Gleason score (0 to 4)x0.71+seminal vesicle involvement (0/1)x0.51. Men with an R(W)' greater than 2.84 (9%) demonstrated a 50% biochemical recurrence rate (prostrate-specific antigen level greater than 0.2 ng/mL) at 3 years and thus were placed in the high-risk group. Kaplan-Meier analyses of biochemical recurrence-free survival demonstrated rapid deviation of the curves based on the R(W)'. This model was cross-validated in the second group of patients and performed with similar results. Furthermore, similar trends were apparent when the model was externally validated on patients treated at the Mayo Clinic.
  
  
  CONCLUSIONS
  We have developed a multivariate Cox proportional hazards model that successfully stratifies patients on the basis of their risk of early prostate cancer recurrence.
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: W W
authors.initials: WW
authors.lastname: Roberts
authors.forename: E J
authors.initials: EJ
authors.lastname: Bergstralh
authors.forename: M L
authors.initials: ML
authors.lastname: Blute
authors.forename: J M
authors.initials: JM
authors.lastname: Slezak
authors.forename: M
authors.initials: M
authors.lastname: Carducci
authors.forename: M
authors.initials: M
authors.lastname: Han
authors.forename: J I
authors.initials: JI
authors.lastname: Epstein
authors.forename: M A
authors.initials: MA
authors.lastname: Eisenberger
authors.forename: P C
authors.initials: PC
authors.lastname: Walsh
authors.forename: A W
authors.initials: AW
authors.lastname: Partin
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000175:diagnosis; D010173:Palpation; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D012044:Regression Analysis; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen