Natural history of progression after PSA elevation following radical prostatectomy

Citation
Cr. Pound et al., Natural history of progression after PSA elevation following radical prostatectomy, J AM MED A, 281(17), 1999, pp. 1591-1597
Citations number
32
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
ISSN journal
0098-7484 → ACNP
Volume
281
Issue
17
Year of publication
1999
Pages
1591 - 1597
Database
ISI
SICI code
0098-7484(19990505)281:17<1591:NHOPAP>2.0.ZU;2-Y
Abstract
Context In men who develop an elevated serum prostate-specific antigen leve l (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is u nknown. Objective To characterize the time course of disease progression in men wit h biochemical recurrence after radical prostatectomy. Design A retrospective review of a large surgical series with median (SD) f ollow-up of 5.3 (3.7) years (range, 0.5-15 years) between April 1982 and Ap ril 1997, Setting An urban academic tertiary referral institution. Patients A total of 1997 men undergoing radical prostatectomy, by a single surgeon, for clinically localized prostate cancer. None received neoadjuvan t therapy, and none had received adjuvant hormonal therapy prior to documen ted distant metastases. Main Outcome Measures After surgery, men were followed up with PSA assays a nd digital rectal examinations every 3 months for the first year, semiannua lly for the second year, and annually thereafter. A detectable serum PSA le vel of at least 0.2 ng/mL was evidence of biochemical recurrence. Distant m etastases were diagnosed by radionuclide bone scan, chest radiograph, or ot her body imaging, which was performed at the time of biochemical recurrence and annually thereafter. Results The actuarial metastasis-free survival for all 1997 men was 82% (95 % confidence interval, 76%-88%) at 15 years after surgery, Of the 1997 men, 315 (15%) developed biochemical PSA level elevation. Eleven of these under went early hormone therapy after the recurrence and are not included in the study. Of the remaining 304 men, 103 (34%) developed metastatic disease wi thin the study period. The median actuarial time to metastases was 8 years from the time of PSA level elevation. in survival analysis, time to biochem ical progression (P<.001), Gleason score (P<.001), and PSA doubling time (P <.001) were predictive of the probability and time to the development of me tastatic disease. An algorithm combining these parameters was constructed t o stratify men into risk groups. Once men developed metastatic disease, the median actuarial time to death was 5 years. The time interval from surgery to the appearance of metastatic disease was predictive of time until death (P<.02). Conclusions Several clinical parameters help predict the outcomes of men wi th PSA elevation after radical prostatectomy. These data may be useful in t he design of clinical trials, the identification of men for enrollment into experimental protocols, and counseling men regarding the timing of adminis tration of adjuvant therapies.