Although surveillance after radical prostatectomy routinely includes repeated prostate specific antigen (PSA)-testing for many years, biochemical recurrence often occurs without further clinical progression. We therefore hypothesised that follow-up can be shortened for many patients without increasing the risk of prostate cancer death. We investigated the long-term probabilities of PSA recurrence, metastases and prostate cancer death in patients without biochemical recurrence five and 10 years after radical prostatectomy.
Prospective cohort study. Stratification by Gleason score (≤3+4=7 or ≥4+3=7), pathological tumour stage (pT2 or ≥pT3) and negative or positive surgical margins.
Between 1989 and 1998, 14 urological centres in Scandinavia randomised patients to the Scandinavian Prostate Cancer Group study number 4 (SPCG-4) trial.
All 306 patients from the SPCG-4 trial who underwent radical prostatectomy within 1 year from inclusion were eligible. Four patients were excluded due to surgery-related death (n=1) or salvage radiotherapy or hormonal treatment within 6 weeks from surgery (n=3).
Cumulative incidences and absolute differences in metastatic disease and prostate cancer death.
We analysed 302 patients with complete follow-up during a median of 24 years. Median preoperative PSA was 9.8 ng/mL and median age was 65 years. For patients without biochemical recurrence 5 years after radical prostatectomy the 20-year probability of biochemical recurrence was 25% among men with Gleason score ≤3+4=7 and 57% among men with Gleason score ≥4+3=7; the probabilities for metastases were 0.8% and 17%; and for prostate cancer death 0.8% and 12%, respectively. The long-term probabilities were higher for pT ≥3 versus pT2 and for positive versus negative surgical margins. Limitations include small size of the cohort.
Many patients with favourable histopathology without biochemical recurrence 5 years after radical prostatectomy could stop follow-up earlier than 10 years after radical prostatectomy.
BMJ open. 2022 Dec 29*** epublish ***
Mats Steinholtz Ahlberg, Hans Garmo, Hans-Olov Adami, Ove Andrén, Jan-Erik Johansson, Gunnar Steineck, Lars Holmberg, Anna Bill-Axelson
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway., Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Gothenburg, Sweden., School of Cancer & Pharmaceutical Sciences, King's College London, London, UK.