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Prognostic Factors for Prostate Cancer Endpoints Following Biochemical Failure: A Review of the Literature.

Nguyen T, Boldt RG, Rodrigues G - Cureus (2015)

Bottom Line: Nineteen eligible studies reported on 8,040 patients that experienced BCF from 1981-2013.There was also heterogeneity in which outcomes were assessed: PCSS (n=14), MFS (n=7), and OS (n=5).The prognostic factors most commonly found to be significant on multivariate analyses were PSA doubling time (PSADT), time to biochemical failure (TTBF), pathological Gleason score (pGS), and age.   Risk stratification in prostate cancer post-BCF is challenging because of limited predictive modeling that can determine which patients will optimally benefit from salvage therapy. Our systematic literature review has identified PSADT, TTBF, pGS, and age as the leading prognostic factors for the prediction of PCSS, MFS, and OS after BCF.

View Article: PubMed Central - HTML - PubMed

Affiliation: Radiation Oncology, London Health Sciences Centre.

ABSTRACT

Purpose: In the setting of biochemical failure (BCF) following primary treatment for prostate cancer, additional discrimination between clinically significant and non-clinically significant biochemical recurrence is critical in defining robust surrogate endpoints for prostate cancer and guiding salvage management decisions. We reviewed the literature to determine which prognostic factors are most significant for predicting prostate cancer-specific survival (PCSS), metastases-free survival (MFS), and/or overall survival (OS) after BCF.

Materials and methods: A search of PubMed from 1980 to 2013 yielded 999 studies that examined prognostic factors predictive for PCSS, MFS, and/or OS in prostate cancer patients with BCF following primary treatment. Eligibility criteria for inclusion were: 1) examined a prostate cancer population in the setting of BCF without overt clinical relapse following primary treatment with radical prostatectomy or radiotherapy; 2) based analyses on patient parameters obtained prior to the initiation of salvage therapies; and 3) determined clinical prognostic factors that were significant prognostic measures for at least one of three clinically relevant endpoints: OS, PCS, or MFS.

Results: Nineteen eligible studies reported on 8,040 patients that experienced BCF from 1981-2013. The initial primary therapy was variable: radical prostatectomy alone (n=8), radiotherapy alone (n=4), radiotherapy/radical prostatectomy ± adjuvant therapy (n=5), and multiple treatment arms (n=2). There was also heterogeneity in which outcomes were assessed: PCSS (n=14), MFS (n=7), and OS (n=5). The prognostic factors most commonly found to be significant on multivariate analyses were PSA doubling time (PSADT), time to biochemical failure (TTBF), pathological Gleason score (pGS), and age.  

Conclusions: Risk stratification in prostate cancer post-BCF is challenging because of limited predictive modeling that can determine which patients will optimally benefit from salvage therapy. Our systematic literature review has identified PSADT, TTBF, pGS, and age as the leading prognostic factors for the prediction of PCSS, MFS, and OS after BCF. We plan to leverage the Canadian ProCaRS database to perform predictive modeling using the putative findings in the present study in order to propose potential evidence-based surrogate endpoints for prostate cancer in the setting of BCF.

No MeSH data available.


Related in: MedlinePlus

Increasing AgeNumber of studies showing age as a significant predictor for PCM, DM, and ACM on multivariate analyses. One study (not represented in the figure) found younger age to be associated with worse PCM and ACM
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FIG2: Increasing AgeNumber of studies showing age as a significant predictor for PCM, DM, and ACM on multivariate analyses. One study (not represented in the figure) found younger age to be associated with worse PCM and ACM

Mentions: There were six studies that examined age as a prognostic indicator in patients following BCF, and there was fair amount of heterogeneity amongst the results. Five studies examined age at BCF, whereas one study examined age at the time of primary treatment [8]. Older age at BCF was weakly significant for ACM on both univariate and multivariate analyses with significance ratios of 1:0 for both. For PCM, older age at BCF was non-significant on univariate analysis (0:1) and weakly significant on multivariate analyses (2:1). Only one study examined the relationship between age and DM, and no significant correlation was found on multivariate analysis (0:1) (Figure 2). Antonarakis, et al. found a significant association between older age at the time of primary surgery and ACM [8]. In addition, one study found younger age was a significant predictor for worse PCM and ACM.


Prognostic Factors for Prostate Cancer Endpoints Following Biochemical Failure: A Review of the Literature.

Nguyen T, Boldt RG, Rodrigues G - Cureus (2015)

Increasing AgeNumber of studies showing age as a significant predictor for PCM, DM, and ACM on multivariate analyses. One study (not represented in the figure) found younger age to be associated with worse PCM and ACM
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494574&req=5

FIG2: Increasing AgeNumber of studies showing age as a significant predictor for PCM, DM, and ACM on multivariate analyses. One study (not represented in the figure) found younger age to be associated with worse PCM and ACM
Mentions: There were six studies that examined age as a prognostic indicator in patients following BCF, and there was fair amount of heterogeneity amongst the results. Five studies examined age at BCF, whereas one study examined age at the time of primary treatment [8]. Older age at BCF was weakly significant for ACM on both univariate and multivariate analyses with significance ratios of 1:0 for both. For PCM, older age at BCF was non-significant on univariate analysis (0:1) and weakly significant on multivariate analyses (2:1). Only one study examined the relationship between age and DM, and no significant correlation was found on multivariate analysis (0:1) (Figure 2). Antonarakis, et al. found a significant association between older age at the time of primary surgery and ACM [8]. In addition, one study found younger age was a significant predictor for worse PCM and ACM.

Bottom Line: Nineteen eligible studies reported on 8,040 patients that experienced BCF from 1981-2013.There was also heterogeneity in which outcomes were assessed: PCSS (n=14), MFS (n=7), and OS (n=5).The prognostic factors most commonly found to be significant on multivariate analyses were PSA doubling time (PSADT), time to biochemical failure (TTBF), pathological Gleason score (pGS), and age.   Risk stratification in prostate cancer post-BCF is challenging because of limited predictive modeling that can determine which patients will optimally benefit from salvage therapy. Our systematic literature review has identified PSADT, TTBF, pGS, and age as the leading prognostic factors for the prediction of PCSS, MFS, and OS after BCF.

View Article: PubMed Central - HTML - PubMed

Affiliation: Radiation Oncology, London Health Sciences Centre.

ABSTRACT

Purpose: In the setting of biochemical failure (BCF) following primary treatment for prostate cancer, additional discrimination between clinically significant and non-clinically significant biochemical recurrence is critical in defining robust surrogate endpoints for prostate cancer and guiding salvage management decisions. We reviewed the literature to determine which prognostic factors are most significant for predicting prostate cancer-specific survival (PCSS), metastases-free survival (MFS), and/or overall survival (OS) after BCF.

Materials and methods: A search of PubMed from 1980 to 2013 yielded 999 studies that examined prognostic factors predictive for PCSS, MFS, and/or OS in prostate cancer patients with BCF following primary treatment. Eligibility criteria for inclusion were: 1) examined a prostate cancer population in the setting of BCF without overt clinical relapse following primary treatment with radical prostatectomy or radiotherapy; 2) based analyses on patient parameters obtained prior to the initiation of salvage therapies; and 3) determined clinical prognostic factors that were significant prognostic measures for at least one of three clinically relevant endpoints: OS, PCS, or MFS.

Results: Nineteen eligible studies reported on 8,040 patients that experienced BCF from 1981-2013. The initial primary therapy was variable: radical prostatectomy alone (n=8), radiotherapy alone (n=4), radiotherapy/radical prostatectomy ± adjuvant therapy (n=5), and multiple treatment arms (n=2). There was also heterogeneity in which outcomes were assessed: PCSS (n=14), MFS (n=7), and OS (n=5). The prognostic factors most commonly found to be significant on multivariate analyses were PSA doubling time (PSADT), time to biochemical failure (TTBF), pathological Gleason score (pGS), and age.  

Conclusions: Risk stratification in prostate cancer post-BCF is challenging because of limited predictive modeling that can determine which patients will optimally benefit from salvage therapy. Our systematic literature review has identified PSADT, TTBF, pGS, and age as the leading prognostic factors for the prediction of PCSS, MFS, and OS after BCF. We plan to leverage the Canadian ProCaRS database to perform predictive modeling using the putative findings in the present study in order to propose potential evidence-based surrogate endpoints for prostate cancer in the setting of BCF.

No MeSH data available.


Related in: MedlinePlus