Clinical factors can help determine risk of prostate cancer death after radical prostatectomy

Clinical factors including the time to biochemical recurrence following surgery can help predict the risk of prostate cancer death for patients following a radical prostatectomy, according to a study in the July 27 issue of JAMA.

Radical prostatectomy (removal of the prostate) is one of the most common treatments for prostate cancer and generally provides excellent cancer control, according to background information in the article. However, approximately 35 percent of patients will develop a prostate-specific antigen (PSA) recurrence ("biochemical recurrence") within 10 years after surgery. Due to the sensitivity of PSA to detect disease recurrence early, many patients have a long interval between biochemical recurrence and the development of local recurrence or distant metastasis.

Given the protracted natural history, the researchers had previously identified clinical variables to help stratify patients for risk of metastasis: time from surgery to biochemical recurrence, pathological Gleason score (a grading system for prostate tumors), and PSA doubling time (PSADT; the time it takes for the PSA value to double). Previous research has confirmed that a short PDADT is a risk factor for clinical progression and prostate cancer-specific death.

Stephen J. Freedland, M.D., of The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, and colleagues conducted a study to 1) identify clinical factors that are associated with increased risk for prostate cancer-specific death following radical prostatectomy, and 2) to identify men who are at high risk and may benefit from aggressive treatment and as well as to identify those men who are at low risk and can be safely observed. The study included 379 men who had undergone radical prostatectomy between 1982 and 2000 and who had a biochemical recurrence. The average follow-up after surgery was 10.3 years.

The researchers found that PSA doubling time (less than 3.0 vs. 3.0-8.9 vs

Contact: Trent Stockton
JAMA and Archives Journals

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