Editor's Commentary - Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: The impact of time from surgery to recurrence

BERKELEY, CA (UroToday.com) - This interesting study appears in the online edition of European Urology.

In it, Dr. Stephen Boorjian and associates reviewed data on 14,632 patients who underwent radical prostatectomy (RP) at the Mayo Clinic between 1990 and 2006. Median followup was 11.5 years and BCR was defined as PSA ≥0.4ng/ml. PSA doubling time (PSADT) was calculated.

They identified 2,426 patients who had BCR and who did not receive neoadjuvant or adjuvant therapy. Mean age at RP was 64 years, median preoperative PSA was 7.9ng/ml, one-third had extra-prostatic disease at RP, and half had pathologic Gleason score ≥7. Most patients who had positive pelvic lymph nodes received adjuvant therapy and thus were not included in the analysis. During a median follow-up of 6.6 years, 375 men (15.5%) received salvage radiotherapy and 264 men (10.9%) received salvage androgen deprivation therapy. A total of 284 patients with BCR experienced systemic progression and 556 died; of these 140 died from CaP. Median systemic progression free survival and cancer-specific survival were not reached at 15 years after BCR, and the estimated 15-year systemic PFD and CSS after BCR was 75.8% and 83.6%, respectively. The median time from RP to BCR was 3.1 years. Patients with early BCR had more advanced tumor stage, higher Gleason score and higher preoperative PSA levels. Their PSADT was greater and they were more likely to receive salvage therapy. The 10-year rate of systemic progression for men who had BCR after 5.9 years was 10%, vs. 19% for men with BCR <1.2 years after RP. The likelihood of death from CaP was lower among patients with a longer interval from RP to BCR; the 10-year CaP mortality with BCR <1.2 years was 9.9% compared with 4.7% for those with BCR >5.9 years after RP. Interestingly, in multivariate analysis the time from RP to BCR was not independently associated with the risks of systemic progression or death from CaP. Older patient age, higher Gleason score, advanced tumor stage, and rapid PSADT predicted systemic progression and death from CaP in patients with BCR. Treatment with salvage therapy did not affect the risks of systemic progression or death from CaP.

Boorjian SA, Thompson RH, Tollefson MK, Rangel LJ, Bergstralh EJ, Blute ML, Karnes RJ



Eur Urol. 2011 Jun;59(6):893-9

PubMed Abstract
PMID: 21388736

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