Contemporary identification of patients at high risk of early prostate cancer recurrence after radical retropubic prostatectomy

Objectives, To develop a model that will identify a contemporary cohort of patients at high risk of early prostate cancer recurrence (greater than 50% at 36 months) after radical retropubic prostatectomy for clinically locali zed disease, Data from this model will provide important information for pa tient selection and the design of prospective randomized trials of adjuvant therapies. Methods. Proportional hazards regression analysis was applied to two patien t cohorts to develop and cross-validate a multifactorial predictive model t o identify men with the highest risk of early prostate cancer recurrence. T he model and validation cohorts contained 904 and 901 men, respectively, wh o underwent radical retropubic prostatectomy at Johns Hopkins Hospital. Thi s model was then externally validated using a cohort of patients from the M ayo Clinic. Results. A model for weighted risk of recurrence was developed: R-w' = lymp h node involvement (0/1) x 1.43 + surgical margin status (0/1) x 1.15 + mod ified Gleason score (0 to 4) x 0.71 + seminal vesicle involvement (0/1) x 0 .51. Men with an R-w' greater than 2.84 (9%) demonstrated a 50% biochemical recurrence rate (prostrate-specific antigen level greater than 0.2 ng/mL) at 3 years and thus were placed in the high-risk group. Kaplan-Meier analys es of biochemical recurrence-free survival demonstrated rapid deviation of the curves based on the R-w'. This model was cross-validated in the second group of patients and performed with similar results. Furthermore, similar trends were apparent when the model was externally validated on patients tr eated at the Mayo Clinic. Conclusions, We have developed a multivariate Cox proportional hazards mode l that successfully stratifies patients on the basis of their risk of early prostate cancer recurrence. UROLOGY 57: 1033-1037, 2001. (C) 2001, Elsevie r Science Inc.