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Predicting Clinical and Biochemical Endpoints after Radical Prostatectomy Andrew J. Stephenson, MD FRCSC FACS Director, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic
Postoperative Predictions: Why? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Postoperative vs. Pretreatment Models ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Postoperative Nomogram Kattan et al.  J Clin Oncol  1999; Graefen et al.  J Clin Oncol  2002;  Bianco et al.  J Urol  2003  Single surgeon, 996 pts, open RP, 1983-1997,  BCR Endpoint: PSA 0.4 ng/mL and rising  Bootstrapped c-index: 0.88  Model predictions remarkably robust when applied to diverse external validation populations C-index 0.80-0.83
Postoperative Nomogram v. 2.0 ,[object Object],[object Object],[object Object],[object Object],[object Object],Stephenson et al.  J Clin Oncol  2005
Deciding Upon Secondary Therapy ,[object Object],Stephenson et al.  In preparation N = 326 pts, median FU 70 mos, externally-validated  on SWOG 8794, c-index 0.67
Building a Better Nomogram? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Svatek et al.  Prostate  2009; Stephenson et al.  J Urol  2009;  Vickers et al.  Cancer  2009
Building a Better Nomogram: Clinical Endpoints ,[object Object],[object Object],[object Object],[object Object],[object Object]
Postoperative Nomogram for PCSM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eggener et al.  J Urol  2011
Postoperative Nomogram for PCSM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eggener et al.  J Urol  2011; Stephenson et al. In preparation * SM’s not associated with PCSM, even after adjusting for postop radiotherapy
Prostate Cancer-Specific Survival: Gleason Score Analysis Eggener et al.  J Urol  2011 Gleason 6 Glsn 3+4 Glsn 4+3 Glsn 8-10 Age < 60 Age 60-69 Age > 69
Prostate Cancer-Specific Survival: Pathological Stage Eggener et al.  J Urol  2011 Organ- Confined EPE SVI LNI Age < 60 Age 60-69 Age > 69
Nomogram Predicting 15-year PCSM ,[object Object],[object Object],[object Object],[object Object],[object Object],Eggener et al.  J Urol  2011
Building a Better Postoperative PCSM Nomogram ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Donovan et al.  J Clin Oncol  2008; Eggener et al.  Cancer  2009
Building a Better Postoperative PCSM Nomogram ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Donovan et al.  J Clin Oncol  2008; Eggener et al.  Cancer  2009
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 

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NY Prostate Cancer Conference - A. Stephenson - Session 4: Predicting clinical and biochemical endpoints after surgery

  • 1. Predicting Clinical and Biochemical Endpoints after Radical Prostatectomy Andrew J. Stephenson, MD FRCSC FACS Director, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic
  • 2.
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  • 4. Postoperative Nomogram Kattan et al. J Clin Oncol 1999; Graefen et al. J Clin Oncol 2002; Bianco et al. J Urol 2003 Single surgeon, 996 pts, open RP, 1983-1997, BCR Endpoint: PSA 0.4 ng/mL and rising Bootstrapped c-index: 0.88 Model predictions remarkably robust when applied to diverse external validation populations C-index 0.80-0.83
  • 5.
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  • 11. Prostate Cancer-Specific Survival: Gleason Score Analysis Eggener et al. J Urol 2011 Gleason 6 Glsn 3+4 Glsn 4+3 Glsn 8-10 Age < 60 Age 60-69 Age > 69
  • 12. Prostate Cancer-Specific Survival: Pathological Stage Eggener et al. J Urol 2011 Organ- Confined EPE SVI LNI Age < 60 Age 60-69 Age > 69
  • 13.
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  • 17.