Which Patients With Undetectable PSA Levels 5 Years After Radical Prostatectomy Are Still At Risk Of Recurrence?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 04 Nov 2010 - 3:00 PDT


If a patient has an undetectable PSA at 5 years post-radical prostatectomy (RP) for prostate cancer (CaP) what's the likelihood of a recurrence at 10 and 13 years? The answer, according to a report in Urology from Deborah Ahove and colleagues is 12% and 18%, respectively. The authors studied 505 men who had undergone RP at the Brigham and Women's Hospital from 1985 to 2000 with at least 5 years of PSA failure-free survival. Patients who received either neoadjuvant androgen deprivation therapy, adjuvant radiotherapy or had positive lymph nodes were excluded. The median post-RP followup was 10.7 years and the primary endpoint was the time interval to PSA failure after 5 years. PSA failure was defined as a PSA level > 0.2ng/ml with a confirmatory level. The investigators also evaluated the time to development of distant metastasis.

The majority of the cohort had favorable risk features; 77% had a pre-RP PSA level <10ng/ml, 79% were pathologic stage T2 disease, 58% had pathologic Gleason score 6 or less and 81% had negative surgical margins. The PSA recurrence-free percentage decreased from 100% at 5 years to 88% at 10 years and 82% at 13 years. The investigators evaluated the variables associated with PSA recurrence in univariate and multivariate analysis. Univariate analysis found Gleason score, pathologic stage, and surgical margin status to be predictive of late PSA recurrence. Multivariate analysis found Gleason score 7 (adjusted HR 1.88), Gleason score 8-10 (adjusted HR 4.81) and extracapsular extension (adjusted HR 2.37) all associated with increased risk of late PSA recurrence. Seminal vesicle invasion trended towards significance. At year 10, PSA failure-free status for patients with stage T2 CaP was 90.4%, for stage T3a CaP it was 82.5%, and for stage T3b CaP it was 61.5%. Evaluating PSA recurrence-free status at 10 years by Gleason score revealed 94.2% for Gleason score 6, 84.5% for Gleason score 7, and 53.6% for Gleason score 8-10 CaP. Among all patients, only 10 men developed distant metastasis after year 5. Multivariate analysis found significant predictors of late distant metastatic recurrence to be extracapsular extension (adjusted HR 5.5), and seminal vesicle invasion (adjusted HR 9.3). For patients with organ-confined CaP, the 10-year metastasis free rate was 99.7%. While Gleason score 7 and above disease was also associated with increased rate of late distant metastasis, no patient with Gleason score 6 cancer developed late distant metastasis and as such, a hazard ratio could not be calculated.

Ahove DA, Hoffman KE, Hu JC, Choueiri TK, D'Amico AV, Nguyen PL

Urology. 2010 Aug 13. Epub ahead of print.

doi: 10.1016/j.urology.2010.03.092

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2010 - UroToday

• Additional
• References
• Citations