Predicting Extrapelvic Disease following primary radiation therapy for prostate cancer
Anatomic patterns of recurrence in patients with a rising prostate-specific antigen after radiotherapy using C-11 choline positron emission tomography/computed tomography were identified. Most recurrences were localized to the pelvis and a tool was generated to aid in disease localization prior to evaluation with advanced imaging.

Note: The current model has not been externally validated. Only after additional validation, the model may prove to be useful for clinical decision making. 
Research authors: William P. Parker, Brian J. Davis, Sean S. Park, Kenneth R. Olivier, Richard Choo, Mark A. Nathan, Val J. Lowe, Timothy J. Welch, Jaden D. Evans, William S. Harmsen, Harras B. Zaid, Ilya Sobol, Daniel M. Moreira, Rimki Haloi, Matthew K. Tollefson, Matthew T. Gettman, Stephen A. Boorjian, Lance A. Mynderse, R. Jeffrey Karnes, Eugene D. Kwon
Details Formula Study characteristics Files & References
★★★
Model author
Model ID
1018
Version
1.6
Revision date
2017-11-08
Specialty
MeSH terms
  • Prostate Cancer
  • Radiotherapy
  • Recurrence
  • PET-CT
  • Prostate Specific Antigen
  • Model type
    Logistic regression (Calculation)
    Status
    public
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    Additional information

    Design, setting, and participants: Retrospective review of 184 patients with a rising prostate-specific antigen (PSA) after RT for CaP.
    Intervention: C-11 choline positron emission tomography/computed tomography (CholPET).
    Outcome measurements and statistical analysis: Recurrence patterns were classified as pelvic soft tissue only (as a surrogate for potentially salvageable disease) versus any extrapelvic disease, and clinical features were compared between patterns. Multivariable logistic regression was used to generate a predictive nomogram for extrapelvic recurrence. Discrimination was assessed with a c-index

    Study Population

    Total population size: 184

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age at radiotherapy 60 65 70 Years
    PSA at diagnosis 5.6 7.8 10.5 ng/mL
    Dose of RT 75.0 75.6 80.0 Gy
    PSA nadir 0.2 0.5 1.1 ng/mL
    PSA at CholPet scan 3.4 5.7 8.9 ng/mL
    Delta PSA 2.9 5.1 7.9 ng/mL
    Time to CholPet from RT 39 68 104 months
    Time to CholPET from nadir PSA 25 47 77 months
    PSA doubling time 6 11 20 months
    PSA velocity 0.6 1.3 2.9 ng/mL/yr

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Gleason pattern ≤6 58
    7 82
    8-10 38
    Grade group 1 (≤3 +3) 59
    2 (3 + 4) 52
    3 (4 + 3) 29
    4 (8) 19
    5 (9 and 10) 19
    Clinical stage T1c 63
    T2a-c 48
    T3a-b 13
    NCCN risk group Low risk 42
    Intermediate risk 82
    High/very high risk 46
    Type of therapy EBRT alone 104
    BT as part of therapy 79
    HT during RT 55
    Target Prostate 137
    Prostate + SV 19
    Prostate + SV + pelvic nodes 13

    Probability of extrapelvic recurrence is:
    ...

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    Result
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    Probability of extrapelvic recurrence is:

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    Outcome stratification

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    Conditional information

    Result interpretation

    The use of the current nomogram may be feasible to inform decisions on which patients should undergo further pelvic imaging and/or confrmatory biopsy before considering local salvage therapy. 

    Note: The current model has not been externally validated. Only after additional validation, the model may prove to be useful for clinical decision making. 

     

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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