Development of a Novel Nomogram to Predict Biochemical Failure and Prostate Cancer-Specific Mortality After...

Area of Science:

• Oncology
• Radiation Oncology
• Prostate Cancer Research

Background:

• Gleason score (GS) 7 prostate cancer (PCa) is biologically heterogeneous.
• Prognoses vary significantly among GS 7 PCa subgroups.
• Definitive radiotherapy (RT) with or without androgen deprivation therapy (ADT) is a common treatment.

Purpose of the Study:

• Assess long-term oncologic outcomes for GS 7 PCa treated with RT.
• Develop a predictive nomogram for patients with GS 7 PCa.
• Stratify individual risk for biochemical failure and cancer-specific survival.

Main Methods:

• Retrospective analysis of 372 patients with GS 7 PCa treated with RT (2010-2020).
• Kaplan-Meier analysis for freedom from biochemical failure (FFBF) and prostate cancer-specific survival (PCSS).
• Cox regression for prognostic factors and nomogram construction; validated with AUC, calibration plots, and decision curve analysis.

Main Results:

• 8-year FFBF and PCSS rates were 88.2% and 96.3%.
• GS 4+3 showed significantly poorer outcomes than GS 3+4 (p=0.010 for FFBF, p=0.002 for PCSS).
• Independent predictors of biochemical failure included young age, PSA >10 ng/mL, GS 4+3, and absence of ADT. Nomogram achieved 8-year AUCs of 0.773 for FFBF and 0.914 for PCSS.

Conclusions:

• GS 4+3, elevated PSA, absence of ADT, and young age are strong predictors of poor outcomes.
• The developed nomogram offers accurate, individualized risk stratification for GS 7 PCa.
• The nomogram may guide treatment intensity and follow-up strategies; external validation is recommended.