External validation of a risk score predicting failure after salvage focal therapy for localized radiorecurrent prostate cancer: an analysis from the focal recurrent assessment and salvage treatment (forecast) trial

You have accessJournal of UrologyCME1 Apr 2023MP73-04 EXTERNAL VALIDATION OF A RISK SCORE PREDICTING FAILURE AFTER SALVAGE FOCAL THERAPY FOR LOCALIZED RADIORECURRENT PROSTATE CANCER: AN ANALYSIS FROM THE FOCAL RECURRENT ASSESSMENT AND SALVAGE TREATMENT (FORECAST) TRIAL Alexander Light, Max Peters, Abi Kanthabalan, Menelaos Pavlou, Rumana Omar, Sola Adeleke, Francesco Giganti, Chris Brew-Graves, Amr Emara, Athar Haroon, Arash Latifoltojar, Harbir Sidhu, Alex Freeman, Clement Orczyk, Ashok Nikapota, Tim Dudderidge, Richard G. Hindley, Heather Payne, Anita Mitra, Jamshed Bomanji, Mathias Winkler, Gail Horan, Shonit Punwani, Hashim U. Ahmed, and Taimur T. Shah Alexander LightAlexander Light More articles by this author , Max PetersMax Peters More articles by this author , Abi KanthabalanAbi Kanthabalan More articles by this author , Menelaos PavlouMenelaos Pavlou More articles by this author , Rumana OmarRumana Omar More articles by this author , Sola AdelekeSola Adeleke More articles by this author , Francesco GigantiFrancesco Giganti More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , Amr EmaraAmr Emara More articles by this author , Athar HaroonAthar Haroon More articles by this author , Arash LatifoltojarArash Latifoltojar More articles by this author , Harbir SidhuHarbir Sidhu More articles by this author , Alex FreemanAlex Freeman More articles by this author , Clement OrczykClement Orczyk More articles by this author , Ashok NikapotaAshok Nikapota More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Richard G. HindleyRichard G. Hindley More articles by this author , Heather PayneHeather Payne More articles by this author , Anita MitraAnita Mitra More articles by this author , Jamshed BomanjiJamshed Bomanji More articles by this author , Mathias WinklerMathias Winkler More articles by this author , Gail HoranGail Horan More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Hashim U. AhmedHashim U. Ahmed More articles by this author , and Taimur T. ShahTaimur T. Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient selection for salvage focal therapy might be improved with risk prediction tools. For men with localized radiorecurrent prostate cancer, we used the FORECAST study to externally validate our previously published risk score for predicting failure post-salvage focal therapy (doi: 10.1016/j.urolonc.2017.08.022). METHODS: Men were included from the prospective, multicentre FORECAST trial (NCT01883128) with≤T3bN0M0 radiorecurrence who had undergone salvage focal high-intensity focused ultrasound (HIFU) or cryotherapy (2014-2018). Recurrence was diagnosed by transperineal template mapping and MRI-targeted biopsies. Staging comprised bone scan and choline PET/CT. The outcome was a composite failure, defined as biochemical failure, localized/distant disease on re-imaging, positive re-biopsy, commencement of systemic hormones or chemotherapy, or cancer-related death. Variables from the original multivariable Cox model were Gleason score, disease-free survival interval, T-stage, prostate volume, and PSA. Model performance at 2 years post-treatment was assessed via discrimination (C-index), calibration plot, and decision curve analysis. RESULTS: 71 men were included (HIFU n=51; cryotherapy n=20). 37 experienced failure (biochemical failure n=20; recurrent disease on imaging n=13; positive biopsy n=2; starting systemic hormones/chemotherapy n=2). Median time-to-failure was 0.93 years (IQR 0.65-1.04). C-index was 0.64 (95%CI 0.53-0.73). The calibration plot demonstrated some overestimation of failure-free survival at lower predictions, and underestimation at higher predictions (Figure 1). Compared to a ‘treat all’ approach, the model had improved net benefit at risk thresholds≥0.43, equating to net benefit for a clinician who would treat at most 3.3 men for 1 of them to be failure-free at 2 years. CONCLUSIONS: In this external validation, this risk score performed modestly in predicting failure post-salvage focal therapy. This score could be used to identify high-risk patients who may benefit from treatment escalation or multimodal treatment. Source of Funding: Funded by the Pelican Cancer Foundation, the US National Institutes of Health, and the UK Medical Research Council © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1035 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Light More articles by this author Max Peters More articles by this author Abi Kanthabalan More articles by this author Menelaos Pavlou More articles by this author Rumana Omar More articles by this author Sola Adeleke More articles by this author Francesco Giganti More articles by this author Chris Brew-Graves More articles by this author Amr Emara More articles by this author Athar Haroon More articles by this author Arash Latifoltojar More articles by this author Harbir Sidhu More articles by this author Alex Freeman More articles by this author Clement Orczyk More articles by this author Ashok Nikapota More articles by this author Tim Dudderidge More articles by this author Richard G. Hindley More articles by this author Heather Payne More articles by this author Anita Mitra More articles by this author Jamshed Bomanji More articles by this author Mathias Winkler More articles by this author Gail Horan More articles by this author Shonit Punwani More articles by this author Hashim U. Ahmed More articles by this author Taimur T. Shah More articles by this author Expand All Advertisement PDF downloadLoading ...