In a study conducted by Choueiri et al. published in Cancer it was suggested that men who have prostate cancer that was treated by a radical prostatectomy (RP) who then had a long time to a biochemical recurrence (BCR) or a long PSA doubling time after a BCR have no higher overall risk of death than men who have not had a recurrence.

The researchers conducted a retrospective analysis of data from 3,071 men who were treated with radical prostatectomy (RP). Their data set expanded over a 20-year period for men who were treated at Duke University (between 1988 and 2008) and for whom complete, long-term follow-up data were available.

The data from this study are reported as follows:

• After a median follow-up of 7.4 years from the time of RP, 546/3,071 men (17.8 percent) men had had a BCR and 454/3,071 men (14.8 percent) had died (of all causes).

• The median follow-up after PSA failure was 11.2 years.

• Time-dependent BCR was associated with a very small increase in risk of death from any cause (adjusted hazards ratio or AHR = 1.03).

• In men who experienced BCR, a PSA doubling time < 6 months was associated with a significantly increased risk of overall death (AHR = 1.55).• In men who received radiotherapy after their BCR, the risk of death was significantly lower (AHR, 0.58).• In men who received hormone therapy after their BCR, the risk of death was also significantly lower (AHR, 0.56).The conclusions of the study are that the occurrence of a biochemical recurrence in men who have had a RP for prostate cancer is associated with an increased risk of death from any cause. The risk of death increased significantly as the time to the recurrence shortened, however the addition of radiotherapy and/or hormone therapy in men with a BCR significantly lowered their risk of death.Older data previously presented from The Johns Hopkins Hospital suggests that men who have a biochemical recurrence accompanied with a PSA doubling time of 15 or more months after RP are at minimal risk for evident prostate cancer metastasis or prostate cancer-specific death, whereas men with a PSA doubling time of 3 months or less are at very high risk.Data from this current study is consistent with the risk level found in the Hopkins research.Perhaps we should consider these two studies when deciding on treatment for men with a biochemical recurrence. A man with a BCR post surgery should look at his PSA doubling time when deciding when to start ADT instead of immediately jumping on the bandwagon. In light of the significant side effects of ADT, early ADT might be avoided for men with a long PSA doubling time.Choueiri TK, Chen MH, D’Amico AV, Sun L, Nguyen PL, Hayes JH, Robertson CN, Walther PJ, Polascik TJ, Albala DM, et al.
Cancer. 2010 Apr 15; 116(8):1887-92.

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