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Prostate Cancer
Volume 2012 (2012), Article ID 814724, 11 pages
http://dx.doi.org/10.1155/2012/814724
Research Article

Risk Stratification after Biochemical Failure following Curative Treatment of Locally Advanced Prostate Cancer: Data from the TROG 96.01 Trial

1School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
2Department of Radiation Oncology, Calvary Mater Newcastle, Locked Bag 7, Hunter Region Mail Centre, NSW 2310, Australia
3Department of Radiation Oncology, Wellington Cancer Centre, Riddiford Street, Newtown, Wellington 6021, New Zealand
4Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, WA 6009, Australia
5Department of Radiation Oncology, Auckland Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
6Department of Radiation Oncology, St George's Cancer Care Centre, 131 Leinster Road, Strowan, Christchurch 8014, New Zealand
7Department of Radiation Oncology, Westmead Hospital, Corner Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia
8Department of Radiation Oncology, Dunedin Hospital, 201 Great King Street, Dunedin 9054, New Zealand
9Department of Radiation Oncology, Premion, Inland Drive, Tugun, QLD 4224, Australia
10Department of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, VIC 3002, Australia

Received 20 July 2012; Revised 3 October 2012; Accepted 12 November 2012

Academic Editor: Harold A. Frazier

Copyright © 2012 Allison Steigler et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. Survival following biochemical failure is highly variable. Using a randomized trial dataset, we sought to define a risk stratification scheme in men with locally advanced prostate cancer (LAPC). Methods. The TROG 96.01 trial randomized 802 men with LAPC to radiation ± neoadjuvant androgen suppression therapy (AST) between 1996 and 2000. Ten-year follow-up data was used to develop three-tier post-biochemical failure risk stratification schemes based on cutpoints of time to biochemical failure (TTBF) and PSA doubling time (PSADT). Schemes were evaluated in univariable, competing risk models for prostate cancer-specific mortality. The performance was assessed by c-indices and internally validated by the simple bootstrap method. Performance rankings were compared in sensitivity analyses using multivariable models and variations in PSADT calculation. Results. 485 men developed biochemical failure. c-indices ranged between 0.630 and 0.730. The most discriminatory scheme had a high risk category defined by PSADT < 4 months or TTBF < 1 year and low risk category by PSADT > 9 months or TTBF > 3 years. Conclusion. TTBF and PSADT can be combined to define risk stratification schemes after biochemical failure in men with LAPC treated with short-term AST and radiotherapy. External validation, particularly in long-term AST and radiotherapy datasets, is necessary.