Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy.

CONTEXT The natural history of biochemical recurrence after radical prostatectomy can be long but variable. Better risk assessment models are needed to identify men who are at high risk for prostate cancer death early and who may benefit from aggressive salvage treatment and to identify men who are at low risk for prostate cancer death and can be safely observed. OBJECTIVES To define risk factors for prostate cancer death following radical prostatectomy and to develop tables to risk stratify for prostate cancer-specific survival. DESIGN, SETTING, AND PATIENTS Retrospective cohort study of 379 men who had undergone radical prostatectomy at an urban tertiary care hospital between 1982 and 2000 and who had a biochemical recurrence and after biochemical failure had at least 2 prostate-specific antigen (PSA) values at least 3 months apart in order to calculate PSA doubling time (PSADT). The mean (SD) follow-up after surgery was 10.3 (4.7) years and median follow-up was 10 years (range, 1-20 years). MAIN OUTCOME MEASURE Prostate cancer-specific mortality. RESULTS Median survival had not been reached after 16 years of follow-up after biochemical recurrence. Prostate-specific doubling time (<3.0 vs 3.0-8.9 vs 9.0-14.9 vs > or =15.0 months), pathological Gleason score (< or =7 vs 8-10), and time from surgery to biochemical recurrence (< or =3 vs >3 years) were all significant risk factors for time to prostate-specific mortality. Using these 3 variables, tables were constructed to estimate the risk of prostate cancer-specific survival at year 15 after biochemical recurrence. CONCLUSION Clinical parameters (PSADT, pathological Gleason score, and time from surgery to biochemical recurrence) can help risk stratify patients for prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. These preliminary findings may serve as useful guides to patients and their physicians to identify patients at high risk for prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy to enroll them in early aggressive treatment trials. In addition, these preliminary findings highlight that survival in low-risk patients can be quite prolonged.

[1]  E. Bergstralh,et al.  PSA doubling time as a predictor of clinical progression after biochemical failure following radical prostatectomy for prostate cancer. , 2001, Mayo Clinic proceedings.

[2]  T. Tammela,et al.  A randomised comparison of bicalutamide ('Casodex') 150 mg versus placebo as immediate therapy either alone or as adjuvant to standard care for early non-metastatic prostate cancer. First report from the Scandinavian Prostatic Cancer Group Study No. 6. , 2002, European urology.

[3]  A. Hanlon,et al.  Short-term androgen deprivation and PSA doubling time: their association and relationship to disease progression after radiation therapy for prostate cancer. , 2004, International journal of radiation oncology, biology, physics.

[4]  F. Harrell,et al.  Evaluating the yield of medical tests. , 1982, JAMA.

[5]  E. Korn,et al.  Effective sample sizes for confidence intervals for survival probabilities. , 1987, Statistics in medicine.

[6]  T. Pickles,et al.  Intervention after PSA failure: examination of intervention time and subsequent outcomes from a prospective patient database. , 2004, International journal of radiation oncology, biology, physics.

[7]  H M Sandler,et al.  Rate of PSA rise predicts metastatic versus local recurrence after definitive radiotherapy. , 1997, International journal of radiation oncology, biology, physics.

[8]  Timothy F. Donahue,et al.  Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy. , 2004, The Journal of urology.

[9]  William J Catalona,et al.  Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. , 2004, The Journal of urology.

[10]  R. B. Smith,et al.  The incidence and significance of detectable levels of serum prostate specific antigen after radical prostatectomy. , 1994, The Journal of urology.

[11]  Michael W Kattan,et al.  Cancer control with radical prostatectomy alone in 1,000 consecutive patients. , 2002, The Journal of urology.

[12]  Ming-Hui Chen,et al.  Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. , 2003, Journal of the National Cancer Institute.

[13]  E. Bergstralh,et al.  Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: continued risk of biochemical failure after 5 years. , 2000, The Journal of urology.

[14]  Michael W Kattan,et al.  Markers and meaning of primary treatment failure. , 2003, The Urologic clinics of North America.

[15]  A. Hanlon,et al.  Posttreatment prostate-specific antigen nadir highly predictive of distant failure and death from prostate cancer. , 2002, International journal of radiation oncology, biology, physics.

[16]  C. Tangen,et al.  Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. , 2004, The New England journal of medicine.

[17]  A. Pollack,et al.  Prostate specific antigen doubling time and disease relapse after radiotherapy for prostate cancer , 1994, Cancer.

[18]  A. Partin,et al.  Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. , 2001, The Urologic clinics of North America.

[19]  S. Hancock,et al.  Prostate specific antigen after radiotherapy for prostate cancer: a reevaluation of long-term biochemical control and the kinetics of recurrence in patients treated at Stanford University. , 1995, The Journal of urology.

[20]  D. Chan,et al.  Natural History of Progression After PSA Elevation Following Radical Prostatectomy , 1999 .

[21]  S. Freedland,et al.  Predictors of metastatic disease in men with biochemical failure following radical prostatectomy. , 2004, The Journal of urology.

[22]  A. Pollack,et al.  Kinetics of serum prostate-specific antigen after external beam radiation for clinically localized prostate cancer. , 1997, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[23]  E. Crawford.  Early versus late hormonal therapy: debating the issues. , 2003, Urology.

[24]  J. Dekernion,et al.  Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. , 1997, The Journal of urology.

[25]  J. Manola,et al.  Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. , 1999, The New England journal of medicine.

[26]  John F Ward,et al.  The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. , 2003, The Journal of urology.

[27]  J. Hanley,et al.  Validation of increasing prostate specific antigen as a predictor of prostate cancer death after treatment of localized prostate cancer with surgery or radiation. , 2004, Journal of Urology.

[28]  I. Tannock,et al.  Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. , 2004, The New England journal of medicine.

[29]  A. Renshaw,et al.  Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  A. D'Amico,et al.  Linear regressive analysis using prostate‐specific antigen doubling time for predicting tumor biology and clinical outcome in prostate cancer , 1993, Cancer.

[31]  Gurkamal Chatta,et al.  Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy , 2003 .

[32]  A. Hanlon,et al.  Validation of a treatment policy for patients with prostate specific antigen failure after three‐dimensional conformal prostate radiation therapy , 2003, Cancer.

[33]  A. Partin,et al.  Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. , 1994, Urology.