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Stratification of Patient Risk Based on Prostate-Specific Antigen Doubling Time After Radical Retropubic Prostatectomy

      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.
      CI (confidence interval), DT (doubling time), HR (hazard ratio), LR (local recurrence), PSA (prostate-specific antigen), SP (systemic progression)
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      REFERENCES

        • Freedland SJ
        • Humphreys EB
        • Mangold LA
        • et al.
        Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy.
        JAMA. 2005; 294: 433-439
        • Roberts SG
        • Blute ML
        • Bergstralh EJ
        • Slezak JM
        • Zincke H.
        PSA doubling time as a predictor of clinical progression after biochemical failure following radical prostatectomy for prostate cancer.
        Mayo Clin Proc. 2001; 76: 576-581
        • Pound CR
        • Partin AW
        • Eisenberger MA
        • Chan DW
        • Pearson JD
        • Walsh PC
        Natural history of progression after PSA elevation following radical prostatectomy.
        JAMA. 1999; 281: 1591-1597
        • Ward JF
        • Blute ML
        • Slezak J
        • Bergstralh EJ
        • Zincke H.
        The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy.
        J Urol. 2003; 170: 1872-1876
        • Cannon Jr, GM
        • Walsh PC
        • Partin AW
        • Pound CR
        Prostate-specific antigen doubling time in the identification of patients at risk for progression after treatment and biochemical recurrence for prostate cancer.
        Urology. 2003; 62: 2-8
        • Blute ML
        • Bergstralh EJ
        • Iocca A
        • Scherer B
        • Zincke H.
        Use of Gleason score, prostate specific antigen, seminal vesicle and margin status to predict biochemical failure after radical prostatectomy.
        J Urol. 2001; 165: 119-125
        • Patel A
        • Dorey F
        • Franklin J
        • deKernion JB
        Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen.
        J Urol. 1997; 158: 1441-1445
        • Dotan ZA
        • Bianco Jr, FJ
        • Rabbani F
        • et al.
        Pattern of prostate-specific antigen (PSA) failure dictates the probability of a positive bone scan in patients with an increasing PSA after radical prostatectomy.
        J Clin Oncol. 2005; 23: 1962-1968
        • D'Amico AV
        • Moul J
        • Carroll PR
        • Sun L
        • Lubeck D
        • Chen MH
        Prostate specific antigen doubling time as a surrogate end point for prostate cancer specific mortality following radical prostatectomy or radiation therapy.
        J Urol. 2004; 172: S42-S46
        • Amling CL
        • Bergstralh EJ
        • Blute ML
        • Slezak JM
        • Zincke H.
        Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point?.
        J Urol. 2001; 165: 1146-1151
        • Moul JW
        Prostate specific antigen only progression of prostate cancer.
        J Urol. 2000; 163: 1632-1642
        • D'Amico AV
        • Moul JW
        • Carroll PR
        • Sun L
        • Lubeck D
        • Chen MH
        Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy.
        J Natl Cancer Inst. 2003; 95: 1376-1383
        • Albertsen PC
        • Hanley JA
        • Penson DF
        • Fine J.
        Validation of increasing prostate specific antigen as a predictor of prostate cancer death after treatment of localized prostate cancer with surgery or radiation.
        J Urol. 2004; 171: 2221-2225
        • Zelefsky MJ
        • Ben-Porat L
        • Scher HI
        • et al.
        Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer.
        J Clin Oncol. 2005; 23: 826-831
        • Ward JF
        • Zincke H
        • Bergstralh EJ
        • Slezak JM
        • Blute ML
        Prostate specific antigen doubling time subsequent to radical prostatectomy as a prognosticator of outcome following salvage radiotherapy.
        J Urol. 2004; 172: 2244-2248
        • Lin DD
        • Schultz D
        • Renshaw AA
        • Rubin MA
        • Richie JP
        • D'Amico AV
        Predictors of short postoperative prostate-specific antigen doubling time for patients diagnosed during the PSA era.
        Urology. 2005; 65: 528-632