Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer

Mack Roach, Carol Marquez, Hae Sook Yuo, Perinchery Narayan, Lorie Coleman, Unyime O. Nseyo, Zarrin Navvab, Peter R. Carroll

Research output: Contribution to journalArticle

323 Citations (Scopus)

Abstract

Purpose: To evaluate the predictive value of an empirically derived equation for identifying patients with clinically localized prostate cancer at low and high risk for harboring occult lymph node metastasis. Methods and Materials: A simple equation for estimating the risk of positive lymph nodes was empirically derived from a nomogram published by Partin et al. demonstrating the value of combining the pre-treatment prostate specific antigen and Gleason Score in predicting the risk of lymph node metastasis for patients with clinically localized prostate cancer. The risk of positive nodes (N+) was calculated using the equation; N+ = 2 3(PSA) + (GS - 6) × 10 where PSA and GS are the pre-treatment prostate specific antigen and Gleason Score respectively, and the calculated risk is constrained between 0-65% for a PSA ≤ 40 ng/ml (as in the nomogram). To test the general applicability of this equation, we reviewed the pathologic features of 282 of our patients who had undergone a radical prostatectomy. Results: Based on 212 patients for whom the pre-operative prostate specific antigen's and Gleason Scores were available, we identified 145 patients with a calculated risk of positive nodes of <15%, (low risk group) and 67 patients with a calculated risk as ≥ 15% (high risk group). The observed incidence of positive nodes was 6% and 40% among the low and high risk groups respectively (p <0.001). When used alone neither clinical stage, pre-treatment prostate specific antigen nor the pre-treatment Gleason Score was as useful in identifying the largest low and high risk groups. Conclusion: Using the equation described we confirmed the general applicability of the nomogram reported by Partin et al. and identified patients at low and high risk for lymph node involvement. Based on these data we have adopted a policy of omitting whole pelvic irradiation in patients identified as low risk.

Original languageEnglish (US)
Pages (from-to)33-37
Number of pages5
JournalInternational journal of radiation oncology, biology, physics
Volume28
Issue number1
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

Fingerprint

Neoplasm Grading
lymphatic system
antigens
Prostate-Specific Antigen
pretreatment
Prostatic Neoplasms
Lymph Nodes
cancer
nomographs
Nomograms
Therapeutics
metastasis
Neoplasm Metastasis
Prostatectomy
estimating
incidence

Keywords

  • Prognostic factors for prostate cancer
  • Prostate cancer
  • Tumor markers

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer. / Roach, Mack; Marquez, Carol; Yuo, Hae Sook; Narayan, Perinchery; Coleman, Lorie; Nseyo, Unyime O.; Navvab, Zarrin; Carroll, Peter R.

In: International journal of radiation oncology, biology, physics, Vol. 28, No. 1, 01.01.1994, p. 33-37.

Research output: Contribution to journalArticle

Roach, Mack ; Marquez, Carol ; Yuo, Hae Sook ; Narayan, Perinchery ; Coleman, Lorie ; Nseyo, Unyime O. ; Navvab, Zarrin ; Carroll, Peter R. / Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer. In: International journal of radiation oncology, biology, physics. 1994 ; Vol. 28, No. 1. pp. 33-37.
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abstract = "Purpose: To evaluate the predictive value of an empirically derived equation for identifying patients with clinically localized prostate cancer at low and high risk for harboring occult lymph node metastasis. Methods and Materials: A simple equation for estimating the risk of positive lymph nodes was empirically derived from a nomogram published by Partin et al. demonstrating the value of combining the pre-treatment prostate specific antigen and Gleason Score in predicting the risk of lymph node metastasis for patients with clinically localized prostate cancer. The risk of positive nodes (N+) was calculated using the equation; N+ = 2 3(PSA) + (GS - 6) × 10 where PSA and GS are the pre-treatment prostate specific antigen and Gleason Score respectively, and the calculated risk is constrained between 0-65{\%} for a PSA ≤ 40 ng/ml (as in the nomogram). To test the general applicability of this equation, we reviewed the pathologic features of 282 of our patients who had undergone a radical prostatectomy. Results: Based on 212 patients for whom the pre-operative prostate specific antigen's and Gleason Scores were available, we identified 145 patients with a calculated risk of positive nodes of <15{\%}, (low risk group) and 67 patients with a calculated risk as ≥ 15{\%} (high risk group). The observed incidence of positive nodes was 6{\%} and 40{\%} among the low and high risk groups respectively (p <0.001). When used alone neither clinical stage, pre-treatment prostate specific antigen nor the pre-treatment Gleason Score was as useful in identifying the largest low and high risk groups. Conclusion: Using the equation described we confirmed the general applicability of the nomogram reported by Partin et al. and identified patients at low and high risk for lymph node involvement. Based on these data we have adopted a policy of omitting whole pelvic irradiation in patients identified as low risk.",
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T1 - Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer

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AU - Marquez, Carol

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AU - Narayan, Perinchery

AU - Coleman, Lorie

AU - Nseyo, Unyime O.

AU - Navvab, Zarrin

AU - Carroll, Peter R.

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AB - Purpose: To evaluate the predictive value of an empirically derived equation for identifying patients with clinically localized prostate cancer at low and high risk for harboring occult lymph node metastasis. Methods and Materials: A simple equation for estimating the risk of positive lymph nodes was empirically derived from a nomogram published by Partin et al. demonstrating the value of combining the pre-treatment prostate specific antigen and Gleason Score in predicting the risk of lymph node metastasis for patients with clinically localized prostate cancer. The risk of positive nodes (N+) was calculated using the equation; N+ = 2 3(PSA) + (GS - 6) × 10 where PSA and GS are the pre-treatment prostate specific antigen and Gleason Score respectively, and the calculated risk is constrained between 0-65% for a PSA ≤ 40 ng/ml (as in the nomogram). To test the general applicability of this equation, we reviewed the pathologic features of 282 of our patients who had undergone a radical prostatectomy. Results: Based on 212 patients for whom the pre-operative prostate specific antigen's and Gleason Scores were available, we identified 145 patients with a calculated risk of positive nodes of <15%, (low risk group) and 67 patients with a calculated risk as ≥ 15% (high risk group). The observed incidence of positive nodes was 6% and 40% among the low and high risk groups respectively (p <0.001). When used alone neither clinical stage, pre-treatment prostate specific antigen nor the pre-treatment Gleason Score was as useful in identifying the largest low and high risk groups. Conclusion: Using the equation described we confirmed the general applicability of the nomogram reported by Partin et al. and identified patients at low and high risk for lymph node involvement. Based on these data we have adopted a policy of omitting whole pelvic irradiation in patients identified as low risk.

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