New Method Assesses Risk Of Advanced Cancer After Prostate Removal

Study Could Benefit Drug Trials

While prostate removal cures most men of their prostate cancer, more than a third show a rise in their prostate specific antigen (PSA) levels in the 10 years following surgery, an early sign that cancer may be returning. Now, in the largest and longest study of its kind, urologists at Johns Hopkins have developed a simple method for assessing the risk these men have for developing deadly metastatic cancer.

"The first thing patients want to know after their PSA rises following surgery is how long they have to live," says Patrick Walsh, M.D., Hopkins' chief of urology, who removed the prostates of the 2000 patients in the study. "And the first thing doctors want to know is what type of follow-up treatment the patient needs. Up until now, there hasn't been any sure way to know."

In the most extensive follow-up study on the natural course of prostate cancer after surgery, Walsh and his colleagues compiled 10,000 patient-years of data from 1982 to 1997. The men were followed for an average of 5.3 years. From this information, they developed a chart physicians and patients can use to pinpoint the risk for developing metastatic cancer, which typically invades the bones of men with prostate cancer.

"Doctors used to say, You've recurred, but we aren't sure what that means,'" says Alan Partin, Ph.D., a co-author on the study, which appears in the May 5, 1999, Journal of the American Medical Association. "Now they can say, You've recurred, and we know your risk for developing advanced cancer.'"

The chart places men into different risk groups using three common measures: the so-called Gleason score from the removed prostate (a measure of the cancer's severity and aggressiveness); timing of the rise in PSA level (either before or after two years post-surgery); and the length of time it took the PSA level to double (either greater or less than 10 months).


Contact: Brian Vastag
Johns Hopkins Medical Institutions

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