PREVAIL Model for Prostate Cancer Survival

PREVAIL Calculator

PSA Level

ng/mL

Gleason Score

Clinical Stage

Predicts overall survival in chemotherapy-naive patients with metastatic castration-resistant prostate cancer.

Why Use

Provides an overall-survival estimate for chemotherapy-naïve mCRPC starting enzalutamide, potentially facilitating prognosis discussions and research stratification.

When to Use

Apply to chemotherapy-naïve (or just-started) patients with metastatic castration-resistant prostate cancer (mCRPC) to estimate prognosis. Best suited for asymptomatic or minimally symptomatic men planning treatment with enzalutamide or, potentially, another first-line androgen-receptor (AR) pathway inhibitor.

Formula

Total score = (treatment x 18.1376) + [(ln(PSA) + 2.3026) x 9.52244917] + [(275.9 - time) x 0.1543483] + [(4.9 - albumin) x 16.0447656796] + [(16.8 - hemoglobin) x 7.7519235] + (neutrophil x 17.613) + (LDH x 19.00635) + (pain x 12.2248) + (bone x 17.7533) + (alkaline x 10.9685) + (spread x 32.991), where variables are as follows (bolded): Variable Points Treatment with enzalutamide planned Yes 0 No 1 Current PSA value, ng/mL Continuous Time since diagnosis, months Continuous Albumin , g/dL Continuous Hemoglobin , g/dL Continuous Neutrophil to lymphocyte ratio (neutrophil number divided by lymphocyte number) <2.5 Yes 0 No 1 LDH below upper limit of normal Yes 0 No 1 Pain 0-1 (on a scale of 0-10, 10 being the worst pain imaginable, highest pain rating in last 24 hrs) Yes 0 No 1 <10 bone metastases on bone scan Yes 0 No 1 Alkaline phosphatase less than upper limit of normal Yes 0 No 1 Pattern of spread No visceral liver metastases 0 Any visceral liver metastases 1

Pearls / Pitfalls

Developed from the phase-3 PREVAIL enzalutamide cohort to better reflect contemporary mCRPC management. Not formally validated with other first-line AR-pathway agents, although the authors suggest it may still be applicable. Not suitable for patients previously exposed to or currently receiving chemotherapy, immunotherapy, or radionuclide therapy, or those with hormone-sensitive, non-metastatic, or heavily-symptomatic disease. Lacks external validation, particularly outside clinical-trial settings, limiting generalizability. Intended only for a single, baseline, pre-treatment prognostication; not designed for serial reassessment. Does not incorporate molecular markers or comorbidities; use alongside a comprehensive evaluation.

Advice

The study authors note limited direct clinical utility. Use as supportive information rather than a sole determinant of care; combine with thorough clinical evaluation, specialist consultation, and sound judgment. Results may be helpful for: Goals-of-care discussions with patients and families. Shaping clinical trial designs. Stratifying patients for clinical trials.

More Information

Refer to Figure 1B in Armstrong 2018 for nomogram for 1-year, 2-year, and 3-year survival. Refer to Figure 2 in Armstrong 2020 for nomogram for 5-year survival.