Prediction of biochemical recurrence after radical prostatectomy. New tool for selecting candidates for adjuvant radiation therapy

Objective: To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy. Materials and method: A retrospective study was conducted on 629 patients with localised prostate cancer (pN0-pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value <0.2 ng/mL at 2-3 months. Biochemical recurrence was defined as a PSA >0.4 ng/mL. A multivariate Cox regression analysis was performed. A score (0-2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation. Results: A total of 19.7% of the patients were pT3, 24.2% had a Gleason score >= 8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score =7 (4+3) (HR, 2.01; P=.008), a Gleason score >= 8 (HR, 3.07; P <.001), a pT3b stage (HR, 1.93; p=.008) and a positive surgical margin (HR, 2.20; P<.001). We assigned 0 points to patients without risk prognosis variables; 1 point to patients with Gleason scores =7 (4+ 3), pT3b or positive surgical margins; and 2 Points to patients with Gleason scores >= 8. The patients with a risk summation <= 2 had >50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation >= 3 had <44% survival free of biochemical recurrence. Conclusion: The patients with a risk summation <= 2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation >= 3 might benefit from adjuvant radiation therapy. (C) 2015 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.