Mortality prospects after a prostate cancer recurrences following a radical prostatectomy has always been assumed to be directly related to the early development of metastases. A study from Melbourne Australia indicates that men with low-risk prostate cancer have good mortality prospects even when they experience early biochemical recurrence.

The first author of the study, Anthony Ta, MBBS, of the Austin Hospital, Melbourne, Australia, told Urology Times “The implication of this study is that if someone has low-risk disease at the time of their prostatectomy, they can be told that their prognosis is good with proper PSA surveillance.”

The study was presented at the AUA annual meeting in Atlanta, Ga. Their data was taken from a retrospective study from the Victorian Radical Prostatectomy Register, a statewide registry of prostate cancer patients. They identified 2,116 men who had a radical prostatectomy between 1995 and 2000. Of these, 695 (33%) developed biochemical recurrence (two consecutive PSA readings of >0.2 ?g/L). The majority (82%) of the recurrences appeared within 5 years of surgery. Using this data they performed regression models to calculate the risk of prostate cancer mortality as a function of time to recurrence.

They found that the time to recurrence effect varies by risk. The interval between treatment and the recurrence was a strong predictor of prostate cancer mortality in men with high-risk disease (Gleason ?7

[primary 4] and stage ?pT3a). However, interval to the recurrence appeared to have a minimal effect, if any, on prostate cancer mortality in men diagnosed with low-risk disease (Gleason ?7 [primary 3] and stage ?pT2c).

“This database is unique in that it allows us to examine radical prostatectomy outcomes on a broad scale as compared to a single institution,” Dr. Bolton, also an author of the paper, said. “This database involves the entire urological community. It accesses single institutions, rural and urban practices, individual practices, and centers of excellence. Every urologist in the state contributed to this study.”

“There was another unanticipated aspect,” added Dr. Bolton. “Intuitively, I would have thought that patients from higher socioeconomic quintiles might have done better than patients in the lower quintiles. But what we found was that once the surgery was completed, outcomes were equivalent regardless of socioeconomic status.”

The study is continuing. It is the hope of the authors that eventually they will be able to assess the impact of prostate cancer recurrence on prostate cancer mortality at 20-year follow-up.

Joel T. Nowak, M.A., M.S.W.