Predictors of prostate cancer-specific mortality following radical prostatectomy or radiation therapy.
4548 Background: PSA-defined recurrence as far out as 10 years following radical prostatectomy (RP) or radiation therapy (RT) for men with clinically localized prostate cancer occurs in up to 30% of cases. Yet a minority of these men will experience prostate cancer-specific mortality (PCSM). This study was performed to define the predictors of PCSM following PSA failure. METHODS: A total of 1159 men with clinically localized prostate cancer treated with RP (N = 498) or RT (N = 661) developed PSA failure and they formed the study cohort. The median follow-up was 5.9 and 5.2 years for the RP and RT groups, respectively. Cox regression analyses were used to evaluate whether previously identified predictors of time to metastasis including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure could also predict time to PCSM following PSA failure. Cumulative incidence method was used to estimate PCSM following PSA failure. RESULTS: The post-treatment PSA-DT < 3 months after RP or RT and a biopsy Gleason score ≥ 8 in patients treated with RT were significantly associated with time to PCSM following PSA failure (Table). Postoperative estimates of PCSM (95% CI) 5 years following PSA failure were 31% (17-45%) versus 1% (0-2%) for patients with a PSA-DT < 3 months versus ≥ 3 months, respectively. Post-RT estimates of PCSM 5 years following PSA failure were 75% (59-92%) versus 35% (24-47%) for patients with a biopsy Gleason ≥ 8 versus ≤ 7 and a PSA-DT < 3 months; these estimates were 15% (0.8-28%) versus 4% (1-6%) for patients with a PSA-DT ≥ 3 months. CONCLUSIONS: Patients at high risk for PCSM following PSA failure can be identified based on the post-RP PSA-DT or the post-RT PSA-DT and biopsy Gleason score. These parameters identify the optimal patient selection for a randomized trial evaluating hormonal therapy with or without Taxotere. [Figure: see text] No significant financial relationships to disclose.
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- Oncology & Carcinogenesis
- 1112 Oncology and Carcinogenesis
- 1103 Clinical Sciences
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Published In
EISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Oncology & Carcinogenesis
- 1112 Oncology and Carcinogenesis
- 1103 Clinical Sciences