Predicting risk of death after radical prostatectomy

Prostate Cancer
Predicting risk of death after radical prostatectomy
By JAMA, Jul 28, 2005 - 11:16:38 PM

Clinical factors including the time to biochemical recurrence following surgery can help predict the risk of prostate cancer death for patients following a radical prostatectomy, according to a study in the July 27 issue of JAMA.

Radical prostatectomy (removal of the prostate) is one of the most common treatments for prostate cancer and generally provides excellent cancer control, according to background information in the article. However, approximately 35 percent of patients will develop a prostate-specific antigen (PSA) recurrence ("biochemical recurrence") within 10 years after surgery. Due to the sensitivity of PSA to detect disease recurrence early, many patients have a long interval between biochemical recurrence and the development of local recurrence or distant metastasis.

Given the protracted natural history, the researchers had previously identified clinical variables to help stratify patients for risk of metastasis: time from surgery to biochemical recurrence, pathological Gleason score (a grading system for prostate tumors), and PSA doubling time (PSADT; the time it takes for the PSA value to double). Previous research has confirmed that a short PDADT is a risk factor for clinical progression and prostate cancer-specific death.

Stephen J. Freedland, M.D., of The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, and colleagues conducted a study to 1) identify clinical factors that are associated with increased risk for prostate cancer-specific death following radical prostatectomy, and 2) to identify men who are at high risk and may benefit from aggressive treatment and as well as to identify those men who are at low risk and can be safely observed. The study included 379 men who had undergone radical prostatectomy between 1982 and 2000 and who had a biochemical recurrence. The average follow-up after surgery was 10.3 years.

The researchers found that PSA doubling time (less than 3.0 vs. 3.0-8.9 vs. 9.0-14.9 vs. 15.0 or more months), pathological Gleason score (7 or less vs. 8-10), and time from surgery to biochemical recurrence (3 or less vs. greater than 3 years) were all significant risk factors for time to prostate-specific death. Using these 3 variables, tables were constructed to estimate the risk of prostate cancer-specific survival at year 15 after biochemical recurrence.

Patients with a PSADT less than 3 months had a median survival of 6 years. Patients with a PSADT less than 3 months, biochemical recurrence 3 years or less after surgery, and a pathological Gleason score of 8-10 had a median survival of 3 years. Patients with a PSADT of 15 or more months and a biochemical recurrence more than 3 years after surgery had a 100 percent prostate cancer-specific survival.

"Using the current data, patients at high risk of death due to prostate cancer can be identified. These patients should be offered aggressive combined multimodality treatment using hormonal and cytotoxic chemotherapy, particularly in light of recent data suggesting that chemotherapy can modestly, but significantly, prolong survival in patients with hormone refractory disease," the authors write.

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