Abstract
Abstract
Background
Radical prostatectomy (RP) has been considered primary treatment for localized prostate cancer. Biochemical recurrence (BCR) occur approximately 20–30% in five year after RP. We aim to develop a novel nomogram to predict BCR-free survival (BCRFS) and performed external validation using a validation cohort that may help clinicians to make better decision for tailoring adjuvant treatment to specific group of patients.
Materials and methods
This retrospective cohort study included 370 localized and regional prostate cancer patients who underwent laparoscopic radical prostatectomy (LRP) in Songklanagarind hospital between January 2010 and December 2019, the patients were divided into two groups (primary cohort and validation cohort). BCR-free survival was created using Kaplan-Meier curve. Predictive factors for BCR were identified with univariable and multivariable analysis using Cox proportional hazards model. Predictive nomogram was created using these identified factors and developed for the prediction of biochemical recurrence free survival (BCRFS) at 1 and 5 years after LRP.
Results
For primary Songklanagarind cohort, BCR was found in 105 patients (44.7%). Overall 1-year BCR-free survival was 52.8%, and 5-year BCR-free survival was 45.7% with median time to BCR of 18.1 months. Multivariable analysis identified unfavorable factor to BCRRF which are high initial serum PSA (> 20) (p < 0.001; HR 3.2), ISUP Gleason grade group > = 3 (p 0.033; HR 2.2), positive surgical margins (p 0.046; HR 1.5), and seminal vesicle involvement (p < 0.001; HR 5.2) and using for develop a novel nomogram to predict BCR. Concordance index 0.78.
Conclusion
Prostate cancer patients with unfavorable factors, including high initial PSA (> 20), ISUP Gleason grade group > = 3, positive margin and extra-prostatic tumor extension are considered high risks and independent predictors of biochemical recurrence. This predictive models could potentially improve the 1 and 5-year BCR prediction after RP, according to the study’s findings and will aid medical professionals in achieving the goal of clinical prediction and creating a proper management for the localized treatment of prostate cancer underwent laparoscopic radical prostatectomy.
Key Questions about Biochemical Recurrence Prediction in Prostate Cancer
The article "Prediction of biochemical recurrence after laparoscopic radical prostatectomy" discusses the development of a nomogram to predict biochemical recurrence-free survival (BCRFS) in patients undergoing laparoscopic radical prostatectomy (LRP) for localized and regional prostate cancer. The study identified key factors influencing BCRFS, including initial serum prostate-specific antigen (PSA) levels, ISUP Gleason grade group, positive surgical margins, and seminal vesicle involvement. The authors suggest that this predictive model could enhance clinical decision-making and tailor adjuvant treatments for patients at higher risk of recurrence.
1. What factors were identified as independent predictors of biochemical recurrence-free survival (BCRFS) after laparoscopic radical prostatectomy (LRP)?
The study identified the following factors as independent predictors of BCRFS:
- High initial serum PSA levels (>20 ng/mL): Patients with elevated preoperative PSA levels had a higher risk of biochemical recurrence.
- ISUP Gleason grade group ≥3: Higher Gleason grade groups, indicating more aggressive tumor characteristics, were associated with increased risk.
- Positive surgical margins: The presence of cancer cells at the surgical margin increased the likelihood of recurrence.
- Seminal vesicle involvement: Tumor extension into the seminal vesicles was a significant risk factor for recurrence.
2. How was the predictive nomogram developed, and what was its performance?
The authors developed a nomogram incorporating the identified risk factors to predict BCRFS at 1 and 5 years post-LRP. The model demonstrated a concordance index of 0.78, indicating good predictive accuracy.
3. What are the clinical implications of this predictive model?
The nomogram provides clinicians with a tool to assess individual patient risk for biochemical recurrence after LRP. This can inform decisions regarding adjuvant therapies and follow-up strategies, potentially improving patient outcomes by tailoring treatment plans to those at higher risk.
