Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era

Abstract

Introduction: We sought to determine predictors for early and late biochemical recurrence following radical prostatectomy among localized prostate cancer patients. Methods: The study included localized prostate cancer patients treated with radical prostatectomy (RP) at the University of Southern California from 1988 to 2008. Competing risks regression models were used to determine risk factors associated with earlier or late biochemical recurrence, defined using the median time to biochemical recurrence in this population (2.9 years after radical prostatectomy). Results:The cohort for this study included 2262 localized prostate cancer (pT2-3N0M0) patients who did not receive neoadjuvant or adjuvant therapies. Of these patients, 188 experienced biochemical recurrence and a subset continued to clinical recurrence, either within (n=19, 10%) or following (n=13, 7%) 2.9 years after RP. Multivariable stepwise competing risks analysis showed Gleason score ≥7, positive surgical margin status, and ≥pT3a stage to be associated with biochemical recurrence within 2.9 years following surgery. Predictors of biochemical recurrence after 2.9 years were Gleason score 7 (4+3), preoperative prostate-specific antigen (PSA) level, and ≥pT3a stage. Conclusions: Higher stage was associated with biochemical recurrence at any time following radical prostatectomy. Particular attention may need to be made to patients with stage ≥pT3a, higher preoperative PSA, and Gleason 7 prostate cancer with primary high-grade patterns when considering longer followup after RP. IntroductionRadical prostatectomy (RP) remains a mainstay of treatment for localized prostate cancer (PCa). However, up to 30% of patients will experience biochemical recurrence (BCR) following RP, [1][2][3][4] of which 20-30% will progress to clinical metastasis or recurrence (CR). 4,5 Although guidelines are available for post-RP surveillance, there is no clear consensus on an optimal followup strategy. 6, 7 Optimal risk stratification is crucial to avoid patient anxiety while tailoring risk-adapted surveillance and potentially earlier adjuvant therapy in those who require it.Existing models and nomograms using preoperative or postoperative clinical and pathologic data provide risk estimates of recurrence. [8][9][10][11][12] Few studies have further examined the timing of BCR after surgery as a possible predictor of metastatic disease and PCa-related mortality 4,5,[13][14][15] or the association of potential risk factors with earlier or later BCR. 1,16,17 Approximately 27% of BCR patients have been reported to experience late BCR. 13 In this study, we sought to determine clinical and pathologic characteristics predictive of early BCR vs. late BCR in a large cohort of patients treated with RP for localized PCa. Methods Patient populationThe University of Southern California maintained an institutional review board-approved database that included prospectively collected clinical data for 4063 males who underwent open radical retropubic prostatectomy with bilateral pelvic...

Expressional profiling of prostate cancer risk SNPs at 11q13.5 identifies DGAT2 as a new target gene

“…The amount of progressive cancers in the prostatectomy tumor sets were the same (60.0% screening set and 61.0% validation set), but the median onset of progression was two times shorter in the screening set (2.1 years) compared with the validation set (4.2 years). Although no statistically significant difference was detected between the sample sets, the median onset time in the screening set can be classified as an early biochemical recurrence and the median onset time in the validation set as a late biochemical recurrence based on a cutoff point 2.91 years, which has been used by others (Shahabi et al, ). The observed tendency toward shorter progression onset in the tumor set of the screening analysis might be a confounding factor since DGAT2 expression has been observed to be positively associated with a biochemical recurrence (Heemers et al, ), but this finding is not related to the SNPs studied here, because the SNPs are not associated with a PSA progression (Nurminen et al, ).…”

Long‐term cancer control outcomes in patients with biochemical recurrence and the impact of time from radical prostatectomy to biochemical recurrence

“…Biochemical recurrence (BCR) occurs in 8‐30% of patients within 10 years of radical prostatectomy (RP) and in some, BCR heralds rapid and aggressive disease, while in others the natural history might be indolent . Moreover, recent studies found similar survival rates for patients with and without BCR at 10 years after RP and the 15‐year probability of death from prostate cancer (PCSM) versus other causes seems to be comparable for patients in both groups .…”

Is There a Relationship Between Biochemical Recurrence and Insulin-like Growth Factor-1 in Patients with Surgical Border Negative Radical Prostatectomy?

“…Shahabi et al have searched risk factors for biochemical relapse in 2262 RP patients. These patients had not received any neoadjuvant or adjuvant treatment (pT2-3N0M0) [20]. In this study, they accepted the first 35 months after RP as early relapse and more than 35 months as late relapse.…”