Natural history of disease progression in patients who fail to achieve an undetectable prostate‐specific antigen level after undergoing radical prostatectomy

Abstract

BACKGROUNDTo the authors' knowledge, the natural history of disease progression to distant metastasis is unknown in men who fail to achieve an undetectable prostate‐specific antigen (PSA) level after radical retropubic prostatectomy (RRP),. The authors assessed the clinical outcome of men with a persistently detectable PSA level after RRP for clinically localized prostate carcinoma.METHODSBetween 1989 and 2002, 160 men failed to achieve an undetectable PSA level (≥ 0.1 ng/mL) after undergoing RRP for clinically localized prostate carcinoma. No patient received adjuvant therapy before documented metastasis. The Kaplan–Meier method was used to estimate distant metastasis‐free survival. Univariate and multivariate Cox proportional hazards regression was used to assess the ability of clinical and pathologic variables to predict distant metastasis‐free survival.RESULTSThe probability of distant metastasis‐free survival at 3 years, 5 years, and 10 years was reported to be 68%, 49%, and 22%, respectively. Seventy‐five men (47%) developed distant metastases after RRP (median time to metastases of 5.0 years; range, 0.5–13 years). The combination of RRP Gleason score, seminal vesicle status, and lymph node status resulted in 3 risk groups for the prediction of distant metastasis‐free survival (hazards ratio [HR] = 1.6; P < 0.01). The slope of PSA changes approximately 3–12 months after RRP at a cutoff value ≥ 0.05 was found to be even more predictive of distant metastasis‐free survival (HR = 2.9; P < 0.01).CONCLUSIONSMany patients remained free of metastatic disease for an extended period despite failing to achieve an undetectable PSA level after undergoing RRP for clinically localized prostate carcinoma. However, other patients experienced rapid disease progression to distant metastasis. The authors defined clinical (PSA slope) and pathologic (Gleason score) prognostic variables to help identify those patients with a higher risk of developing distant metastasis after undergoing RRP. Cancer 2004. © 2004 American Cancer Society.

Persistently elevated prostate-specific antigen at six weeks after radical prostatectomy helps in early identification of patients who are likely to recur

“…Even without risk factor of biochemical recurrence, the progression rate was significant. Rogers et al [6] demonstrated that 38% of men who fail to achieve an undetectable PSA level will experience slow disease progression and remain free of distant metastases for C7 years. Nevertheless, 32% of patients in this study were reported to develop metastases within 3 years.…”

“…However, men with persistently elevated PSA immediately after surgery, even less than 0.2 ng/ml, seem to be at higher risk for biochemical recurrence, disease progression, and disease-specific mortality [6]. Several studies have used PSA persistence as a marker of adverse outcome, but its significance remains unclear.…”

Ca Prostate with Oral Metastases: A Case Report and Literature Review

“…Early manifestation of the oral soft tissues metastases resemble reactive lesions, such as pyogenic granuloma and peripheral giant cell granuloma. Because of its rarity, the diagnosis of a metastatic lesion in the oral region is challenging, both to the clinician and to the pathologist, in recognizing that a lesion is metastatic and in determining the primary site [10]. Torn Daley in 2011, reported 38 cases of oral metastases, mostly to the mandible followed by the gingiva, mucosa and the alveolar ridge, the most common primary sites were the prostate 8 cases, the lung 7 cases, the breast 5 cases, squamous cell carcinomas 4 cases, renal cancer 3 cases, ca colon 2 cases, hepatocellular cancer 2 cases, thyroid cancer one case and unknown primary 6 cases [11].…”

Greatest Percentage Involved Core Length and Risk of Clinically Significant Prostate-Specific Antigen Failure After Radical Prostatectomy

“…A PSADT < 10-month failure was assigned to men with a persistently positive PSA level at 1 month after RP without evidence of residual prostatic tissue in the surgical bed on magnetic resonance imaging (MRI), because this has been associated with a high risk of distant metastatic disease. 21 Given that a PSADT of 10-month failure is also possible, we modeled the interval to PSADT < 10-month failure using a competing risks method. Specifically, univariable and multivariable Fine and Gray's competing risk regression analysis was used to assess whether an increasing GPC was associated with an increased risk of PSADT < 10-month failure, adjusting for age, PPB, and risk group.…”