Despite the fact that we have already had a radical prostatectomy, at some point in time one third of us will receive that dreaded telephone call from our doctor…. our PSA has reappeared! Once again, we start the process of climbing into the tube for an MRI, we have a bone scan and of course we repeat the PSA to eliminate the possibility of lab error.

This time we have a much clearer understanding of the implication of that positive PSA. We now have graduated to the head of the class, we have advanced recurrent prostate cancer! We now have a disease that is incurable!

However, advanced prostate cancer is treatable. In most cases our first line of treatment is to begin hormone therapy, aka hormone blockade. We ask, what will happen to us at this stage?

The usual response in the clinical research world is to analyze the data with the goal of developing a nomogram to predict our potential survival.

Here is one such example.

Joel T. Nowak, Ma., MSW

Abstract
Prostate Cancer-Specific Survival in Men Treated with Hormonal Therapy after Failure of Radical Prostatectomy Christopher R. Portera, Andrea Gallinab, Koichi Kodamaa, Robert P. Gibbonsa, Roy Correa, Jr.a, Paul Perrotteb and Pierre I. Karakiewiczb, *aDivision of Urology, Virginia Mason Medical Center, Seattle, WA, United States. bCancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, QC, Canada — *Corresponding author. Pierre I. Karakiewicz, MD, MPH, Director, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada, H2X 2J6. Tel. +1 514 890 8000 35336; Fax: +1 514 412 7411. Email: pierre.karakiewicz@umontreal.ca — Accepted 3 November 2006. Available online 20 November 2006.

Objectives. We hypothesized that prostate cancer-specific survival (PCaSS) could be accurately predicted in men in whom radical prostatectomy (RP) failed and who received hormonal therapy (HT) after RP failure. Methods. Between 1954 and 1994, 752 consecutive patients underwent RP without neoadjuvant therapy. Of those, 114 patients (15.2%) received HT at RP failure and represent the focus of this analysis. Cox regression models and a nomogram targeted PCaSS. The main predictor was timing of HT initiation: at prostate-specific antigen (PSA) versus local versus distant recurrence. Covariates included age at HT, pathologic T stage, surgical margin status and Gleason sum at RP, use of adjuvant or salvage radiation, and time from RP to HT.Results. Mean and median follow-up periods were 5.1 and 3.9 yr; 70 deaths were recorded, of which 45 (39.8%) were due to PCa. At 1, 5, 10, and 15 yr, the estimates of PCaSS were, respectively, 97.1%, 68.3%, 49.3%, and 30.2% (median, 9.8 yr). Younger men and those with HT initiated at the time of distant recurrence had lower PCaSS. A nomogram predicting PCaSS at 2, 3, 4, and 5 yr after RP was developed and demonstrated 66% accuracy after 200-bootstrap internal validation.Conclusion. Despite RP failure, half the patients can expect to survive for 10 yr. The nomogram can help in discriminating between those with better versus worse PCaSS, better than relying on most educated guesses.Take Home Message. At 1, 5, 10, and 15 yr, 97.1%, 68.3%, 49.3%, and 30.2% of men treated with radical prostatectomy (RP) and hormonal therapy after RP failure will not die of prostate cancer. A prognostic nomogram for these patients is 66% accurate.Keywords: Hormone therapy; Prostate cancer; Radical prostatectomy; Survival

Copyright © 2006 European Association of Urology Published by Elsevier B.V.

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