Prostate-Specific Antigen Doubling Time Subgroups And Their Associated Contributions To All-Cause Mortality

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 11 Jun 2007 - 0:00 PDT

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UroToday.com- The management of patients with a rising PSA after radical prostatectomy remains controversial. Aside from pathologic stage initial PSA and Gleason score further variables are greatly needed to stratify patients based on risk for clinical trials.

In the May issue of the Journal of Clinical Oncology, Freedland and colleagues from Duke, USC, and Johns Hopkins used their clinical experience to assess 379 patients who had developed a rising PSA after their initial prostatectomy (performed between 1982 and 2000). PSA velocity data was available for all patients. The cohort was followed for a median and mean of 11 and 11.4 years, respectively. PSA recurrence was defined as a postoperative serum PSA of 0.2ng/ml or greater, a median of 4 serum PSA determinations were used to calculate the PSA doubling time.

Of the entire cohort those patients with a PSA doubling time of less than 3 months represented 13% of all cancer deaths, those with an intermediate PSADT (3 9 months) represented 58% of all prostate cancer deaths, and patients with a PSADT less than 15 months (n= 221) accounted for 90% of all prostate cancer deaths.

These data suggest that in patients who experience a biochemical recurrence after radical prostatectomy, 77% will eventually died of prostate cancer if followed for 15 years or longer. As stated in the discussion, contrary to the belief in the lay community, when a young prostate cancer patient recurs after prostatectomy, he is more likely to die "of prostate cancer" than "with prostate cancer." A PSA doubling time of less than 15 months after prostatectomy may reliably select patients for novel clinical trial strategies since their prostate cancer related death approaches 90 percent.

Freedland S.J, Humphreys E.B, Mangold L.A, Eisenberger M, Dore F.J, Walsh P.C, Partin A.W

J Clin. Oncol. 25(13):1765-71, May 2007.
DOI: 10.1200/JCO.2006.08.0572

Reported by UroToday.com Contributing Editor Ricardo F. Sánchez-Ortiz, MD.

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