Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen.

PURPOSE We studied the correlation between prostate specific antigen (PSA) doubling time or, equivalently, log slope PSA and clinical recurrence in patients with detectable PSA after radical retropubic prostatectomy who were followed expectantly. MATERIALS AND METHODS In patients with PSA recurrence after radical retropubic prostatectomy log slope PSA was determined from the difference in the 2 log PSA values divided by the time between readings in months. For a given slope the corresponding PSA doubling time was calculated as log x 2 divided by the slope of the log PSA line. When the initial PSA value was considerably greater than 0.4 ng./ml., the log slope PSA plot was extrapolated to determine the time point at which PSA would have become detectable (0.4 ng./ml.). The relationship between these values, and the time and pattern of clinical recurrence were studied. RESULTS In this series of 77 patients 80% with PSA doubling time of 6 months or greater remained clinically disease-free compared to 64% with PSA doubling time less than 6 months. PSA doubling time had better correlation with time to clinical recurrence after PSA became detectable (p <0.001 Cox proportional hazards model) than Gleason sum, pathological stage or margin status. Biochemical recurrence within 3 months was associated with early clinical recurrence (p <0.002). In addition, short PSA doubling time, that is a high log slope, regardless of the time at which PSA became positive was strongly associated with clinical recurrence (p <0.001). Distant recurrence was invariably associated with short PSA doubling time. Conversely, local recurrence reliably correlated with long PSA doubling time, that is a low log slope. CONCLUSIONS After PSA became detectable PSA doubling time or, equivalently, log slope PSA, was a better indicator of the risk and time to clinical recurrence after radical retropubic prostatectomy than preoperative PSA, specimen Gleason sum or pathological stage. Hormone treatment may be targeted to patients at high risk for early metastatic clinical recurrence, appropriately timed radiation can be offered for proved local recurrence in those with long PSA doubling time and expectant treatment may be proposed for those with long PSA doubling time who remain clinically disease-free. Frequent and expensive imaging does not appear to be cost-effective in this latter group.

[1]  E. Bergstralh,et al.  Stage D1 prostate cancer treated by radical prostatectomy and adjuvant hormonal treatment. Evidence for favorable survival in patients with DNA diploid tumors , 1992, Cancer.

[2]  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.

[3]  R. B. Smith,et al.  Prostate specific antigen levels after radical prostatectomy in patients with organ confined and locally extensive prostate cancer. , 1992, The Journal of urology.

[4]  A W Partin,et al.  Serum PSA after anatomic radical prostatectomy. The Johns Hopkins experience after 10 years. , 1993, The Urologic clinics of North America.

[5]  E. Messing,et al.  Prostate specific antigen: not detectable despite tumor progression after radical prostatectomy. , 1989, The Journal of urology.

[6]  M. Blute,et al.  Radical prostatectomy for stage A adenocarcinoma of the prostate: staging errors and their implications for treatment recommendations and disease outcome. , 1991, The Journal of urology.

[7]  W. Taylor,et al.  Treatment options for patients with stage D1 (T0-3,N1-2,M0) adenocarcinoma of prostate. , 1988, Urology.

[8]  H. Levin,et al.  Correlation of clinical and pathologic factors with rising prostate-specific antigen profiles after radical prostatectomy alone for clinically localized prostate cancer. , 1996, Urology.

[9]  J. Moul,et al.  Radical prostatectomy for clinical stage T1-2N0M0 prostatic adenocarcinoma: long-term results. , 1990, The Journal of urology.

[10]  R. Vessella,et al.  The value of serum prostate specific antigen determinations before and after radical prostatectomy. , 1989, The Journal of urology.

[11]  R. E. Cunningham,et al.  Prognostic significance of DNA ploidy in carcinoma of prostate. , 1989, Urology.

[12]  W. Catalona,et al.  Clinical use of prostate specific antigen in patients with prostate cancer. , 1989, The Journal of urology.

[13]  F. Marshall,et al.  Selection of men at high risk for disease recurrence for experimental adjuvant therapy following radical prostatectomy. , 1995, Urology.

[14]  W. Catalona,et al.  5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. , 1994, The Journal of urology.

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

[16]  P. Goodman,et al.  A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. , 1989, The New England journal of medicine.

[17]  P. Schellhammer.  Combined androgen blockade for the treatment of metastatic cancer of the prostate. , 1996, Urology.

[18]  P. Goodman,et al.  Leuprolide With and Without Flutamide in Advanced Prostate Cancer , 1990, Cancer.

[19]  T. Stamey,et al.  Prostate-Specific Antigen as a Serum Marker for Adenocarcinoma of the Prostate , 1987 .

[20]  J. Oesterling,et al.  Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. , 1994, The Journal of urology.

[21]  P. Carroll,et al.  Local recurrence after radical prostatectomy: characteristics in size, location, and relationship to prostate-specific antigen and surgical margins. , 1996, Urology.

[22]  A. Partin,et al.  Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years. , 1994, The Journal of urology.

[23]  J E Fowler,et al.  Prostate specific antigen progression rates after radical prostatectomy or radiation therapy for localized prostate cancer. , 1994, Surgery.