OncologyDelayed Prostate-specific Antigen Recurrence After Radical Prostatectomy: How to Identify and What Are Their Clinical Outcomes?
Section snippets
Material and Methods
A cohort of 4561 men who underwent radical prostatectomy (RP) between 1988 and 2008 was obtained from the Duke Prostate Center database. PSAR was defined as a PSA level of ≥ 0.2 ng/mL, 30 days after RP.1 Of 4561 men, 1207 (26.5%) had PSAR and were included in this study. Patients were then divided into 2 groups; PSAR before 5 years (early PSAR) and PSAR after 5 years (delayed PSAR). Metastases were defined as a patient having a positive bone scan, CT scan, or chest x-ray. The cause of death was
Results
Of the original cohort of 4561 men, 1207 (31.4%) patients had PSAR. Approximately 90% of PSAR occurred within 5 years after RP (Fig. 1). There was a marginally significant difference (P = .062) in metastasis-free survival between the 2 groups (Fig. 2A). Patients with delayed PSAR had a disease-specific survival advantage (P = .025) compared to patients with early PSAR (Fig. 2B). The median time to metastasis in the delayed PSAR group was 10.5 years after RP, with an interquartile range of
Comment
Our study showed that delayed PSAR (PSAR after 5 years) has significant clinical implications. PSAR had been a well-established marker for failed local therapy.6 Many models have been established that use variables such as race, prostate weight, pathologic Gleason sum, clinical stage, and preoperative PSA to predict patients who are at increased risk of PSAR.2, 3 Outcomes of PSAR can range from recurrence with minimal clinical implications, to metastatic disease and death from prostate cancer.
Conclusions
Approximately 90% of PSAR occurred within 5 years after RP. Time to PSAR is an independent variable predictive of disease-specific survival. A lower pathologic Gleason sum and lower PSA at diagnosis are associated with delayed PSAR. There is a marginal significance between delayed PSAR and metastasis-free survival. Patients with delayed PSAR have greater disease-specific survival as compared to patients with early PSAR.
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