Clinical factors can help determine risk of prostate cancer death after
radical prostatectomy

27 Jul 2005

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.

(JAMA. 2005;294:433-439)
JAMA and Archives Journals
http://www.jamamedia.org

       

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
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