October 21, 2015

Updated Nomogram Predicts Modern Outcomes After Salvage Radiotherapy Following Radical Prostatectomy

Study involved more than 3,000 patients at 10 institutions

ASTRO_690x380
Rahul Tendulkar, MD

Rahul Tendulkar, MD

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

A contemporary update of a 2007 predictive nomogram for salvage radiotherapy after radical prostatectomy offers a modernized forecast of cure compared to its predecessor.

“This (updated nomogram) can have an immediate impact by providing patients and clinicians with an accurate and personalized method of predicting their chances of successful treatment,” says Rahul D. Tendulkar, MD, of Cleveland Clinic Cancer Center, lead author on the study that informs the nomogram update. “It may also help patients and clinicians decide whether to be more aggressive with treatment, or perhaps consider participating in a clinical trial. Also, it may help determine the urgency of treating patients sooner rather than later.”

Original nomogram was first of its kind

A nomogram incorporates multiple data points and returns a graphical computation, simplifying decision-making. The 2007 nomogram was the first of its kind for predicting the outcome of salvage radiation therapy (SRT) for recurrent prostate cancer after prostatectomy. It was created by Andrew J. Stephenson, MD, who is currently the Director of the Center for Urologic Oncology at Cleveland Clinic. It demonstrated that an increasing serum prostate-specific antigen (PSA) level was the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy (RP).

SRT might eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lacked sensitivity and specificity, Dr. Stephenson noted in 2007. The original nomogram predicted the probability of cancer control at six years after SRT for PSA-defined recurrence by evaluating markers such as cancer stage, tumor grade and PSA level.

Advertisement

Updated nomogram focuses on treatment at earlier signs of recurrence

The updated 2016 nomogram takes into account the more recent trend of treating patients at lower PSA levels than in the past (“early SRT”). Randomized trials published since the original nomogram was created have demonstrated the benefit of early SRT in high-risk patients.

“We found that treatment at lower PSA levels does indeed improve the chance of cure,” says Dr. Tendulkar. He describes the updated nomogram in an abstract presented to the 57th annual meeting of the American Society for Radiology Oncology (ASTRO) in San Antonio, Texas.

The 2016 study was a multi-institutional collaborative effort including more than 2,400 patients from 10 institutions. It represents the largest series in the literature regarding SRT after RP, Dr. Tendulkar says.

The retrospective cohort study examined 2,460 patients with a median follow-up of 5 years from the end of radiation. Early SRT was associated with improved freedom from biochemical failure and freedom from distant metastases.

The updated nomogram is designed to better estimate individual patient outcomes after SRT. “The nomogram can give an estimate of the five- and 10-year rates of developing (or not developing) a biochemical recurrence (by elevated PSA) or distant metastases,” says Dr. Tendulkar. “While we describe rates at specific benchmark times, in some cases late recurrences can indeed happen.”

Advertisement

New nomogram will be available to clinicians, patients worldwide

Once the study is published, the nomogram will be made available online at no charge. “Patients and clinicians worldwide can utilize the information to help make decisions regarding treatment,” says Dr. Tendulkar.

Were findings a surprise? “Our hypothesis was consistent with the study outcome,” he says. “We have known that certain factors can predict patient outcomes. This nomogram provides a more refined predictive tool than previously available.”

The next steps, says Dr. Tendulkar, will include conducting subset analyses to learn more about which patients need what kind of treatment. Ideally, clinical trials could be designed based on these findings.

Related Articles

Doctor measuring patient's waist size
February 26, 2024
Impact of Obesity on GVHD & Transplant Outcomes in Hematologic Malignancies

Findings highlight an association between obesity and an increased incidence of moderate-severe disease

Physician with patient
February 21, 2024
Strategies for Improving Clinical Trial Equity

Cleveland Clinic Cancer Institute takes multi-faceted approach to increasing clinical trial access

How antibody drug conjugates work
February 13, 2024
Real-World Use of Trastuzumab Deruxtecan

Key learnings from DESTINY trials

24-CNR-4545611-CQD-Podcast-967×544
February 1, 2024
Possibilities of CRISPR Technology (Podcast)

Gene editing technology offers promise for treating multiple myeloma and other hematologic malignancies, as well as solid tumors

Disparities in multiple myeloma
January 25, 2024
Major Study Identifies Global Disparities in Drug Toxicity for Multiple Myeloma Treatment

Study of 401,576 patients reveals differences in cancer burdens as well as overall survival

Dr. Shilpa Gupta
December 27, 2023
A New Standard Emerges in Advanced Urothelial Carcinoma After Decades of First-Line Chemotherapy

Enfortumab plus pembrolizumab reduced risk of death by 53% compared with platinum-based chemotherapy

23-CNR-4318382-CQD-Hero-650×450 Dr Hill
December 19, 2023
Active Surveillance may be a Feasible Option for a Subset of Patients with Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Large cohort study finds no reduction in survival for patients managed with active surveillance compared to treated patients

Dr. Caimi
December 15, 2023
CAR-T Cell Therapy Effective in Refractory Double-Hit/Triple-Hit Lymphoma

Two thirds of patients responded to CAR T-cell therapy

Ad