Risk of Prostate Cancer–Specific Mortality Following Biochemical Recurrence After Radical Prostatectomy

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Abstract
Radical prostatectomy is one of the most common treatments for prostate cancer and generally provides excellent cancer control. However, approximately 35% of patients will develop a prostate-specific antigen (PSA) recurrence within 10 years after surgery.1-4 Due to the exquisite 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. To help counsel these patients and their physicians, we previously analyzed a cohort of 304 men who had undergone radical prostatectomy and had a subsequent biochemical recurrence, of whom 131 had PSA doubling time (PSADT) data available.5 In that report, the median time from biochemical recurrence to metastasis was 8 years and from metastasis to death was 5 years. Given this protracted natural history, we identified clinical variables to help stratify patients for risk of metastasis: time from surgery to biochemical recurrence, pathological Gleason score, and PSADT. Since our initial report, other series have confirmed that a short PSADT is a risk factor for clinical progression and prostate cancer–specific mortality.6-8 To further define the natural history of patients with biochemical relapse after radical prostatectomy, we sought to identify risk factors for prostate cancer–specific mortality following radical prostatectomy using an expanded cohort with a longer follow-up. We also attempted to identify patients who were at high risk for prostate cancer–specific mortality who would be candidates for clinical trials evaluating the role of early aggressive interventions.

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