Purpose: Although models exist that place patients into discrete groups at various risks for disease recurrence after surgery for prostate cancer, we know of no published work that combines pathologic factors to predict an individual’s probability of disease recurrence. Because clinical stage and biopsy Gleason grade only approximate pathologic stage and Gleason grade in the prostatectomy specimen, prediction of prognosis should be more accurate when postoperative information is added to preoperative variables. Therefore, we developed a postoperative nomogram that allows more accurate prediction of probability for disease recurrence for patients w ho have received radical prostatectomy as treatment for prostate cancer, compared with the preoperative nomogram we previously published.

Patients and Methods: By Cox proportional hazards regression analysis, we modeled the clinical and pathologic data and disease follow-up for 996 men with clinical stage T1a-T3c NXM0 prostate cancer w ho w ere treated w ith radical prostatectomy by a single surgeon at our institution. Prognostic va ria bles included pretrea tment serum prostate-specific antigen level, specimen Gleason sum, prostaticcapsular invasion, surgical margin status, seminal vesicle invasion, and lymph node status. Treatment failure w as recorded w hen there w as either clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ng/mLor greater and rising), or initiation of adjuvant therapy. Validation w as performed on this set of men and a separate sample of 322 men from five other surgeons’ practices from our institution. Results: Cancer recurrence was noted in 189 of the 996 men, and the recurrence-free group had a median follow-up period of 37 months (range, 1 to 168 months). The 7-year recurrence-free probability for the cohort was 73%(95% confidence interval, 68% to 76%). The predictions from the nomogram appeared to be accurate and discriminating, w ith a validation sample area under the receiver operating characteristic curve (ie, a comparison of the predicted probability w ith the actual outcome) of 0.89.

Conclusion: A postoperative nomogram has been developed that can be used to predict the 7-year probability of disease recurrence among men treated with radicalprostatectomy.