A new nomogram to predict pathologic outcome following radical prostatectomy

Alexandre Crippa,Marcos F Dall’Oglio,Luciano J Nesrallah,Alberto A Antunes,Valdemar Ortiz,Katia R Leite,Miguel Srougi

doi:10.1590/s1677-55382006000200005

Abstract

To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical prostatectomy for clinical localized prostate cancer. Nine hundred and sixty patients with clinical stage T1 and T2 prostate cancer were evaluated following radical prostatectomy, and 898 were included in the study. Following a multivariate analysis, nomograms were developed incorporating serum PSA, biopsy Gleason score, and percentage of positive biopsy cores in order to predict the risks of extraprostatic tumor extension, and seminal vesicle involvement. In univariate analysis there was a significant association between percentage of positive biopsy cores (p < 0.001), serum PSA (p = 0.001) and biopsy Gleason score (p < 0.001) with extraprostatic tumor extension. A similar pathologic outcome was seen among tumors with Gleason score 7, and Gleason score 8 to 10. In multivariate analysis, the 3 preoperative variables showed independent significance to predict tumor extension. This allowed the development of nomogram-1 (using Gleason scores in 3 categories - 2 to 6, 7 and 8 to 10) and nomogram-2 (using Gleason scores in 2 categories - 2 to 6 and 7 to 10) to predict disease extension based on these 3 parameters. In the validation analysis, 87% and 91.1% of the time the nomograms-1 and 2, correctly predicted the probability of a pathological stage to within 10% respectively. Incorporating percent of positive biopsy cores to a nomogram that includes preoperative serum PSA and biopsy Gleason score, can accurately predict the presence of extraprostatic disease extension in patients with clinical localized prostate cancer.

Highlights

Gleason grade from biopsy, along with serum PSA and tumor extent at digital rectal examination, are the current most common parameters used to predict the risk of organ confined disease and choose a definitive treatment in patients with prostate cancer (1).some studies show that clinical stage as defined at digital rectal examination is neither the ideal method to choose a definitive therapy (2) nor to predict biochemical outcome after treatment (3-6)
Nomogram to Pathologic Outcome Following Radical Prostatectomy prostatectomy did not find statistical difference in disease recurrence rates among patients staged as T2a, T2b or T2c at digital rectal examination after a 10 years follow up period (7)
New variables to predict the probabilities of organ confined disease and disease recurrence after treatment have been widely studied (8-10), and the percentage of positive biopsy cores (PPBC) for cancer has emerged as an independent prognostic factor (11-13)

Summary

Introduction

Gleason grade from biopsy, along with serum PSA and tumor extent at digital rectal examination, are the current most common parameters used to predict the risk of organ confined disease and choose a definitive treatment in patients with prostate cancer (1).some studies show that clinical stage as defined at digital rectal examination is neither the ideal method to choose a definitive therapy (2) nor to predict biochemical outcome after treatment (3-6). Gleason grade from biopsy, along with serum PSA and tumor extent at digital rectal examination, are the current most common parameters used to predict the risk of organ confined disease and choose a definitive treatment in patients with prostate cancer (1).

Results

Conclusion