Prostate cancer patients often face tough questions about whether, when, and how to treat their disease—questions that can also be difficult for physicians. Thanks to Fox Chase researchers, making informed decisions just became easier.
Doctors often use a tool called a nomogram, which takes into account tumor stage and other factors, to determine a prognosis and guide treatment for men diagnosed with prostate cancer. A better prognosis might support a “watch and wait” approach, while a more serious prediction could argue for immediate treatment. Fox Chase researchers have developed a new nomogram that calculates the prognosis of patients who already have undergone therapy and show signs of recurrence.
After a patient undergoes radiation therapy, doctors monitor the level of prostate-specific antigen in his blood, since an increase in PSA—known as “biochemical failure”—can signal the cancer’s return. Patients in bio-chemical failure often face difficult questions about next steps; some therapies that slow cancer’s growth also cause numerous side effects. “We haven’t really had much information to guide us,” says radiation oncologist Mark Buyyounouski.
Buyyounouski collaborated with an international team to develop the tool using data from more than 2,130 patients in biochemical failure. They found that the sooner failure occurred following the end of radiation therapy, the more likely the patient was to develop metastases and to die of the disease. The researchers presented their findings in October at the annual meeting of the American Association for Radiation Oncology.
Doctors can enter information including a patient’s PSA level, tumor stage, and time before biochemical failure to estimate his five- and 10-year risk of death.
“It’s a very useful tool,” Buyyounouski says. “The decision to start a new treatment is often difficult, especially since patients rarely have symptoms when PSA levels return. If a patient knew he had a 50-percent risk of dying of prostate cancer in the next five years, that may make it easier to decide to pursue treatment.”
The researchers are creating an online version of the tool that will be freely available to the public, starting later this year, via the Fox Chase website at foxchase.org.