ORLANDO, FL, USA (UroToday.com) - The authors presented their experience with the natural history of metastatic progression in men with a PSA recurrence following radical prostatectomy (RP). This is an update to previously reported work from the same institution, now with up to 25 years of follow-up after surgery.
A retrospective single-institution review was undertaken of 774 men who experienced a PSA recurrence following RP from 1982-2008 with a median follow-up of 8 years. This cohort is notable because no patient received adjuvant therapy until the development of clinically detectable metastatic disease. Factors influencing the development of metastatic disease were assessed.
Of the 774 men with a PSA recurrence, 295 (38%) developed metastatic disease and 443 (57%) had adequate PSA doubling time (PSAD) information to be included in the final analysis. The mean PSA at the time of metastasis was 90.3 ng/ml. Using Cox regression analysis PSAD, Gleason score and time to PSA recurrence were predictive of progression to metastatic disease. Median actuarial metastasis-free survival from PSA recurrence for men with PSAD of <3 months was 1 year compared to that of 15 years for men with a PSAD of >15 months. Age, race, pathologic stage and margin status were not significant predictors of progression to metastasis.
The authors concluded that freedom from metastasis following PSA recurrence can be extensive but is highly variable depending on specific clinical variables. These data can facilitate patient counseling and enables a logical risk-based approach to adjuvant treatment planning. Furthermore, this information may be useful when designing and selecting appropriate patients for clinical trials.
Presented by E. S. Antonarakis, MD, et al. at the 45th Annual Meeting of the American Society of Clinical Oncology (ASCO) - May 29 - June 2, 2009 - Orange County Convention Center, Orlando, Florida USA.
Written by UroToday.com Contributing Medical Editor Thomas J. Guzzo, MD, MPH, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions.
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