A study from Michael T. Schweizer, MD, and colleagues at Johns Hopkins University in Baltimore Md. concluded that the longer the metastasis-free survival after a radical prostatectomy the longer overall survival in men who experience biochemical recurrence (PSA only recurrence) of their prostate cancer.
This conclusion was made from a retrospectively study of 450 men with biochemically recurrent prostate cancer defined as a PSA level of 0.2 ng/mL or higher after radical prostatectomy. Tey found that in this sample of 450 men metastatic disease developed in 140 of them. Androgen deprivation therapy (ADT) was deferred until after development of metastases.
The cohort of men had a median metastasis-free survival (MFS) of 10.2 years and the median overall survival (OS) after the development of metastasis was 6.6 years. The researchers then adjusted for other known prognostic variables. They concluded that increasing metastasis-free survival was associated with a decreasing risk of death.
They also found that the number of metastases a man had, the presence or absence of pain with the metastases, and use or non-use of bisphosphonates predicted overall survival time. Men with three or fewer metastases had a 50% decreased risk of death compared with those who had four or more metastases. Men who did not have pain with their metastases had a 57% decreased risk of death compared with those who had pain. Men who used bisphosphonates had a 40% decreased risk of death compared with those who did not use bisphosphonates.
The study findings suggest that MFS may be a reasonable proximal endpoint when evaluating future novel treatments for men who experience biochemical recurrence after surgery. It also suggests that the use of bisphosphonates (which delay the development of metastatic disease) in men who have a biochemical recurrence may also contribute to an increased survival period.
(Reported online ahead of print in the Annals of Oncology)
Joel T Nowak, M.A., M.S.W.