(UroToday.com) The 2024 European Association of Urology (EAU) annual congress held in Paris, France between April 5th and 8th was host to an abstract session on treatment intensification to improve prostate cancer outcomes. Joshua Tran presented the results of an analysis evaluating the use of PSA doubling time kinetics as a clinical marker to potentially avoid unnecessary treatment in the post-radical prostatectomy biochemical recurrence setting in a cohort of patients with long-term follow-up.
Prostate cancer biochemical recurrence remains an unreliable predictor of disease progression, as defined by the need for salvage hormone and/or radiotherapy. A significant proportion of biochemical recurrence events do not result in prostate cancer mortality, which suggests the opportunity for careful monitoring/observation, with a potential subset of patients avoiding salvage therapy and the associated side effects. The objective of this study was to evaluate oncologic outcomes in such men who did not receive immediate androgen deprivation therapy (ADT) or radiotherapy and who had 9 – 21-year follow-up outcomes available.
This was a retrospective cohort analysis, using prospectively collected data, of patients who experienced biochemical recurrence between 2002 and 2014. Patients that received salvage ADT or radiotherapy were excluded. Sequential PSA levels were collected and used to calculate PSA doubling time.
This analysis included a total of 105 patients who were managed with ‘active observation’.
Of the 105 patients managed with ‘active observation’, 86 (82%) were considered a “success”, with an average of 11.1 years follow-up without receipt of salvage ADT or radiotherapy. Of the 86 patients who remained treatment-free, 61 (71%) had increasing PSA doubling times. Conversely, 25 (29%) patients had decreasing PSA doubling times.
Based on these results, the investigators concluded that:
- In men 9 to 21 years post-radical prostatectomy, 37% of men with biochemical recurrence were managed with active observation with the goal of avoiding salvage ADT/radiotherapy.
- To date, 86 of 105 patients (82%) managed initially with ‘active observation’ have safely avoided ADT/radiotherapy, and just 1 of 105 active observation candidates (0.9%) has died of prostate cancer.
- PSA doubling time patterns can be safely used to direct treatment plans for patients with little or no risk of prostate cancer-specific mortality.
Presented by: Joshua Tran, MS, Clinical Research Coordinator, University of California Irvine Health, Orange County, CA
Written by: Rashid Sayyid, MD, MSc - Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 European Association of Urology (EAU) annual congress, Paris, France, April 5th - April 8th, 2024