OBJECTIVES
To assess the risk of local recurrence, systemic progression, and death from cancer
among patients who experience biochemical relapse after radical retropubic prostatectomy
and to stratify those patients by prostate-specific antigen (PSA) doubling time (DT).
PATIENTS AND METHODS
We identified patients who experienced biochemical recurrence (defined as a PSA level
≥0.4 ng/mL) after radical prostatectomy from January 1, 1990, to December 31, 1999,
for prostate adenocarcinoma. The PSA-DT was calculated by log linear regression using
all PSA values within 2 years of biochemical recurrence. Local recurrence- and systemic
progression-free survival and cancer-specific survival were estimated using the Kaplan-Meier
method and analyzed by the log-rank test and Cox models.
RESULTS
Biochemical recurrence was noted in 1521 (27%) of 5533 men during the follow-up period.
Of the 1064 patients with a calculable PSA-DT, 322 (30%) had a PSA-DT of less than
1 year, 357 (34%) had a PSA-DT of 1 to 9.9 years, and 385 (36%) had a PSA-DT of 10
years or more. Patients with a PSA-DT of 10 years or more were less likely to have
a higher preoperative PSA level, Gleason score, advanced pathologic stage, and seminal
vesicle invasion. Patients with a PSA-DT of 10 years or more were at low risk of local
recurrence (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.06-0.14; compared
with patients with a PSA-DT of <1 year), systemic progression (HR, 0.05; 95% CI, 0.02-0.13),
or death from cancer (HR, 0.15; 95% CI, 0.05-0.43).
CONCLUSIONS
Prostate-specific antigen DT is an independent predictor of clinical disease recurrence
and mortality after surgical biochemical failure. Risk stratification into high-,
intermediate-, and low-risk categories based on the PSA-DT provides helpful clinical
information and assists in the development of salvage therapy trials.
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© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
