Yesterday, November 11, 2009, I wrote that I appreciated knowing what my survival chances were after learning that I had a returning PSA, so I thought that this study was particularly relevant.

At the American Society for Radiation Oncology (ASTRO) conference, Dr. Buyyounouski and his colleagues from the Fox Chase Cancer Center reported on a retrospective analysis they performed of 2,132 prostate cancer survivors. All the men where from a single-institution and all of them had received radiation as a first-line treatment for localized prostate cancer. They found that men who had a rising PSA within 18 months of the primary treatment are at a significantly increased risk of death from prostate cancer compared to those whose PSA only starts to rise after 18 months.

They reported that over the sample the median time from treatment to biochemical failure was 35.2 months, but 19 percent of patients developed biochemical failure within 18 months of the primary treatment. (Biochemical failure was defined by the Phoenix criterion of a PSA value increasing to > 2 ng/ml above the nadir, post-irradiation PSA level.)

The 5-year, cancer-specific survival for patients who developed biochemical failure within the first 18 months was 69.5 percent compared with 89.8 percent for those who developed biochemical failure after 18 months from primary treatment.

“We haven’t known if having PSA rise sooner means a patient has a greater danger of dying of prostate cancer, though it seems logical,” said Buyyounouski. “Now we can use the simple criteria from this study, which is widely available for anyone who has PSA testing, to identify men who have a greater than 25 percent chance of dying from prostate cancer in the next 5 years.

According to Buyyounouski, the data from this study suggest that second-line treatment should begin as soon as biochemical failure is detected in men who experience it within 18 months of their initial radiation, “without waiting for other signs or symptoms of prostate cancer.”

From my perspective (see the post of November 11), I would want to know so that I could both start aggressive treatment quickly and plan my today’s.

Joel T Nowak MA, MSW