Comparison of the Walz Nomogram and Presence of Secondary Circulating Prostate Cells for Predicting Early Biochemical Failure after Radical Prostatectomy for Prostate Cancer in Chilean Men.

Cynthia Fuentealba,Nigel P Murray,Omar Jacob,Nelson Orellana,Eduardo Reyes

doi:10.7314/apjcp.2015.16.16.7123

Abstract

To determine the utility of secondary circulating prostate cells for predicting early biochemical failure after radical prostatectomy for prostate cancer and compare the results with the Walz nomagram. A single centre, prospective study of men with prostate cancer treated with radical prostatectomy between 2004 and 2014 was conducted, with registration of clinical-pathological details, total serum PSA pre-surgery, Gleason score, extracapsular extension, positive surgical margins, infiltration of lymph nodes, seminal vesicles and pathological stage. Secondary circulating prostate cells were obtained using differential gel centrifugation and assessed using standard immunocytochemistry with anti-PSA. Biochemical failure was defined as a PSA >0.2ng/ml, predictive values werecalculated using the Walz nomagram and CPC detection. A total of 326 men participated, with a median follow up of 5 years; 64 had biochemical failure within two years. Extracapsular extension, positive surgical margins, pathological stage, Gleason score ≥ 8, infiltration of seminal vesicles and lymph nodes were all associated with higher risk of biochemical failure. The discriminative value for the nomogram and circulating prostate cells was high (AUC >0.80), predictive values were higher for circulating prostate cell detection, with a negative predictive value of 99%, sensitivity of 96% and specificity of 75%. The nomagram had good predictive power to identify men with a high risk of biochemical failure within two years. The presence of circulating prostate cells had the same predictive power, with a higher sensitivity and negative predictive value. The presence of secondary circulating prostate cells identifies a group of men with a high risk of early biochemical failure. Those negative for secondary CPCs have a very low risk of early biochemical failure.

Highlights

After radical prostatectomy for prostate cancer approximately 25-30% of patients will eventually experience a biochemical failure, defined as a total serum PSA of >0.2ng/ml (Hull et al, 2002; Porter et al, 2006)
Materials and Methods: A single centre, prospective study of men with prostate cancer treated with radical prostatectomy between 2004 and 2014 was conducted, with registration of clinical-pathological details, total serum PSA pre-surgery, Gleason score, extracapsular extension, positive surgical margins, infiltration of lymph nodes, seminal vesicles and pathological stage
We present a prospective study of Chilean men who have undergone radical prostatectomy and compare the predictions of the Walz nomogram with the presence of secondary CPCs and clinical outcomes

Summary

Introduction

After radical prostatectomy for prostate cancer approximately 25-30% of patients will eventually experience a biochemical failure, defined as a total serum PSA of >0.2ng/ml (Hull et al, 2002; Porter et al, 2006) Two thirds of these biochemical failures will occur in the first two years and implies a biologically more aggressive disease and poorer prognosis (Dilloglugil et al, 1997). Produced a nomogram based on the total serum PSA at surgery, the presence or absence of extracapsular penetration, seminal vesicle and lymph node infiltration, positive or negative surgical margins and pathological Gleason score from the surgical piece This externally validated nomogram, it tends to over-estimate the risk of biochemical failure, identifies a group of men with a high risk of early biochemical failure. These individuals could be considered for adjuvant treatments, some data have shown benefits to early therapy (MRC Working Party, 1997; Messing et al, 2006) this still is controversial

Methods

Results

Conclusion