title: Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy.
abstract: OBJECTIVE
  An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence.
  
  
  METHODS
  Using multivariable Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients.
  
  
  RESULTS
  The 6-year progression-free probability was 32% (95% CI, 28% to 35%) overall. Forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P < .001), prostatectomy Gleason grade (P < .001), PSA doubling time (P < .001), surgical margins (P < .001), androgen-deprivation therapy before or during SRT (P < .001), and lymph node metastasis (P = .019). The resultant nomogram was internally validated and had a concordance index of 0.69.
  
  
  CONCLUSIONS
  Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level.
authors.affiliation: Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, USA. stephea2@ccf.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Pisansky
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Slawin
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Anscher
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Michalski
authors.forename: Howard M
authors.initials: HM
authors.lastname: Sandler
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Forman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Larry L
authors.initials: LL
authors.lastname: Kestin
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.forename: Theodore L
authors.initials: TL
authors.lastname: DeWeese
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
authors.forename: Richard K
authors.initials: RK
authors.lastname: Valicenti
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
mesh_terms: D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D049451:Nomograms; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen