Researchers at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and the Walter Reed Army Medical Center evaluated metastasis-free survival (MFS) and overall survival (OS) among men with a biochemical reoccurrence (PSA only) of prostate cancer after having received a radical prostatectomy but did not receive additional therapy until developing metastases

They performed a retrospective analysis on data from the Center for Prostate Disease Research National Database which comprised of five US military hospitals and one civilian center. They looked at men who experienced a PSA relapse (?0.2 ng/mL) after radical prostatectomy who had no additional therapy until the time of radiographic metastatic disease.

The researchers investigated factors influencing metastasis and all-cause mortality using univariate and multivariate Cox regression analysis and found that:

1- Among men with survival data (n= 346) the 10-year OS was 79% after a median follow-up of 8.6 years from biochemical recurrence.

2- Among men with metastasis disease (n= 190) the 10-year MFS was 46% after a median follow-up of 7.5 years.

3- In Cox regressions, four clinical factors (Gleason score, pathological stage, time to PSA relapse and PSA doubling time), as well as age, were predictive of OS and/or MFS in univariate analysis, although only PSA doubling time (?9 vs 3-8.9 vs < 3 months) remained independently predictive of these outcomes in multivariate analysis (P < 0.001).This multi-center, multi-ethnic data set shows that OS and MFS can be extensive for men with PSA-recurrent prostate cancer, even in the absence of further therapy before metastasis . This unique patient cohort, the second largest of its type after the Johns Hopkins cohort, confirms that PSA doubling time is the strongest determinant of OS and MFS in men with PSA-recurrent disease. Longer follow-up and more events will be required to determine whether other variables may also contribute to these outcomes.

These finds are consistent with the findings from yesterday’s post, “Biochemical Failure of Prostate Cancer Treatment – When to Treat and When to Watch” at:

BJU Int. 2010 Nov 23. Epub ahead of print; doi: 10.1111/j.1464-410X.2010.09878.x; Antonarakis ES, Chen Y, Elsamanoudi SI, Brassell SA, Da Rocha MV, Eisenberger MA, McLeod DG.

PubMed Abstract
PMID: 21091976

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