title: Prediction of biochemical recurrence after radical prostatectomy. New tool for selecting candidates for adjuvant radiation therapy.
abstract: OBJECTIVE
  To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy.
  
  
  METHODS
  A retrospective study was conducted on 629 patients with localised prostate cancer (pN0-pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value <0.2ng/mL at 2-3 months. Biochemical recurrence was defined as a PSA >0.4ng/mL. A multivariate Cox regression analysis was performed. A score (0-2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation.
  
  
  RESULTS
  A total of 19.7% of the patients were pT3, 24.2% had a Gleason score ≥ 8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score =7 (4+3) (HR, 2.01; P=.008), a Gleason score ≥ 8 (HR, 3.07; P <.001), a pT3b stage (HR, 1.93; p=.008) and a positive surgical margin (HR, 2.20; P<.001). We assigned 0 points to patients without risk prognosis variables; 1 point to patients with Gleason scores =7 (4+3), pT3b or positive surgical margins; and 2 points to patients with Gleason scores ≥ 8. The patients with a risk summation ≤ 2 had >50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation ≥ 3 had <44% survival free of biochemical recurrence.
  
  
  CONCLUSIONS
  The patients with a risk summation ≤ 2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation ≥ 3 might benefit from adjuvant radiation therapy.
authors.affiliation: Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: felipeherranz@telefonica.net.
authors.forename: F
authors.initials: F
authors.lastname: Herranz-Amo
authors.affiliation: Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Molina-Escudero
authors.affiliation: Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: G
authors.initials: G
authors.lastname: Ogaya-Pinies
authors.affiliation: Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: D
authors.initials: D
authors.lastname: Ramírez-Martín
authors.affiliation: Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: Verdú-Tartajo
authors.affiliation: Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Hernández-Fernández
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology; D018579:Patient Selection; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen
keywords: Adjuvant radiation therapy; Biochemical recurrence; Cáncer de próstata; Factores pronósticos; Prognostic factors; Prostate cancer; Radioterapia adyuvante; Recidiva bioquímica