Risk of Prostate Cancer–Specific Mortality Following Biochemical Recurrence After Radical Prostatectomy

Freedland, Stephen J.; Humphreys, Elizabeth B.; Mangold, Leslie A.; Eisenberger, Mario A.; Dorey, Frederick J.; Walsh, Patrick C.; Partin, Alan W.

doi:10.1001/jama.294.4.433

Cited by 1,238 publications

(789 citation statements)

References 31 publications

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“…The pGS is the best predictor of the natural history of PCa because all other variables depend on it [13,14,15,16]. We showed that serum TT was a significant preoperative variable associated with tumor grade and it ranked above PSA (tables 2, 3).…”

Section: Discussionmentioning

confidence: 82%

“…It has been shown that the prostatectomy Gleason score (pGS) is the factor that best predicts biochemical recurrence, development of metastases and PCa-specific mortality since all other variables (baseline PSA, PSA doubling time, pathologic stage) depend on it [13,14,15,16]. Also, the association of pretreatment serum TT levels with pGS still remains a controversial and unsolved subject [4,6,7,10,11,12,17,18,19,20,21,22,23,24,25,26,27,28].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Serum Total Testosterone Is a Significant Preoperative Variable Independently Contributing to Separating the Prostate Cancer Population into Prostatectomy Gleason Score Groups

Porcaro

Petrozziello²,

Ghimenton³

et al. 2013

Urol Int

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Aim: To investigate the potential of preoperative serum total testosterone (TT) in contributing to the definition of separate prostatectomy Gleason score (pGS) groups of the prostate cancer (PCa) population. Materials and Methods: The data of 220 patients operated on for PCa were retrospectively reviewed. No patient had previously received 5α-reductase inhibitor, luteinizing hormone-releasing analogs or testosterone replacement treatment. The patient population was grouped according to the pGS as 6 = 3+3, 7 = 3+4, 7 = 4+3 and 8-10. Eight variables were simultaneously investigated in each group: prostate-specific antigen (PSA), TT, free testosterone, age, percentage of positive prostate biopsy cores (P+), biopsy Gleason score (bGS), overall cancer volume estimated as percentage of prostate volume (V+) and prostate weight (Wi). Univariate analysis of variance (ANOVA), multivariate analysis of variance (MANOVA) and multivariate discriminant analysis (MDA) were the statistical methods used for evaluating the data. Results: There were 89 patients in pGS 6 = 3+3, 84 in pGS 7 = 3+4, 24 in pGS 7 = 4+3 and 23 in pGS 8-10. ANOVA showed that bGS (p < 0.0001), P+ (p < 0.0001), V+ (p < 0.0001), PSA (p = 0.0001), Wi (p = 0.0002) and TT (p = 0.01) were significantly different in the four pGS groups. MANOVA tests showed that only bGS (p < 0.0001), V+ (p = 0.0003), TT (p = 0.001) and, to a lesser extent, PSA (p = 0.06) were the significant variables that individually and independently contributed a significant amount to separation of the four pGS groups of the PCa population. MDA showed that the independent variables ranked as bGS (p < 0.0001), TT (p = 0.001), V+ (p = 0.001) and PSA (p = 0.06). Conclusions: Serum TT is a significant preoperative variable that independently contributes to separating the PCa population into pGS score groups. Pretreatment baseline serum TT levels should be measured and their inclusion in neural networks predicting PCa natural history be considered in the patient population diagnosed with PCa.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Serum Total Testosterone Is a Significant Preoperative Variable Independently Contributing to Separating the Prostate Cancer Population into Prostatectomy Gleason Score Groups

Porcaro

Petrozziello²,

Ghimenton³

et al. 2013

Urol Int

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“…Il est aussi de mise en cas de récidive biologique, locale ou métastatique, et de contre-indication du traitement local à un stade localisé 1 . L'HAA réduit les niveaux sériques de la testostérone, qui passent d'un taux normal d'environ 500 à 600 ng/dl (17,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)8 nmol) à un taux de castration. Classiquement, la castration est considérée comme efficace si le taux de testostérone a été abaissé à un seuil de 50 ng/dl (soit 1,73 nmol/l) ou à une valeur inférieure à 5 % du taux normal 2,3 .…”

Section: Introductionunclassified

“…On assiste également à une forte augmentation de l'utilisation de l'HAA pour traiter les formes localisées de cancer de la prostate 5 . La médiane de survie est de 16 ans chez les patients ayant connu une récidive après prostatectomie radicale 6 . Le taux de survie est de 80 % 10 ans après la récidive si le temps de dédoublement du PSA est égal ou supérieur à 6 mois 7 .…”

Section: Introductionunclassified

Complications de l’hormonothérapie anti-androgénique du cancer de la prostate

Ziouziou

Karmouni²,

Khader³

et al. 2014

CUAJ

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RésuméLes effets indésirables de l'hormonothérapie anti-androgénique (HAA) dans le traitement du cancer de la prostate sont attribuables à la carence d'androgènes. L'HAA entraîne le syndrome de castration, qui se caractérise par une diminution de la libido, la dysfonction érectile, l'asthénie, des bouffées de chaleur, la diminution des capacités intellectuelles et la dépression. Il en résulte égale-ment une augmentation de la graisse abdominale, ce qui favorise l'insulinorésistance et le diabète. La perte de la densité minérale osseuse secondaire à l'HAA entraîne un risque fracturaire accru. Il existe de plus un risque cardiovasculaire important dû aux facteurs métaboliques. L'effet thérapeutique de l'HAA doit donc être soupesé en regard de la toxicité liée à l'hypogonadisme.

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“…In fact, most patients will not develop any clinical manifestations despite having BCR. 6,18,24 Evidence suggests that adjuvant radiation therapy should be offered to high-risk patients after RP. [10][11][12][13] Critics to this approach cite that this modality was not compared to early salvage therapy in pivotal studies, as well as that more recent trials have failed to demonstrate a survival benefit.…”

Section: Discussionmentioning

confidence: 99%

Time from first detectable PSA following radical prostatectomy to biochemical recurrence: A competing risk analysis

Boo

Pintilie

Yip

et al. 2015

CUAJ

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Introduction: In this study, we estimated the time from first detectable prostate-specific antigen (PSA) following radical prostatecfollowing radical prostatectomy (RP) to commonly used definitions of biochemical recurrence (BCR). We also identified the predictors of time to BCR. Methods: We identified subjects who underwent a RP and had an undetectable PSA after surgery followed by at least 1 detectable PSA between 2000 and 2011. The primary outcome was time to BCR (PSA ≥0.2 and successive PSA ≥0.2) and prediction of the rate of PSA rise. Outcomes were calculated using a competing risk analysis, with univariable and multivariable Fine and Grey models. We employed a mixed effect model to test clinical predictors that are associated with the rate of PSA rise. Results: The cohort included 376 patients. The median follow-up from surgery was 60.5 months (interquartile range [IQR] 40.8-91.5) and from detectable PSA was 18 months (IQR 11-32). Only 45.74% (n = 172) had PSA values ≥0.2 ng/mL, while 15.16% (n = 57) reached the PSA level of ≥0.4 ng/mL and rising. On multivariable analysis, the values of the first detectable PSA and pathologic Gleason grade 8 or higher were consistently independent predictors of time to BCR. In the mixed effect model rate, the PSA rise was associated with time from surgery to first detectable PSA, Gleason score, and prostate volume. The main limitation of this study is the large proportion of patients that received treatment without reaching BCR. It is plausible that shorter estimated median times would occur at a centre that does not use salvage therapy at such an early state. Conclusion:The time from first detectable PSA to BCR may be lengthy. Our analyses of the predictors of the rate of PSA rise can help determine a personalized approach for patients with a detectable PSA after surgery. IntroductionRadical prostatectomy (RP) is the surgical treatment of choice for clinically localized prostate cancer. Prostatespecific antigen (PSA) monitoring is the primary tool for detecting relapse of cancer after RP. About 27% to 53% of men undergoing RP will have a detectable serum PSA within 10 years of surgery.1-5 Although biochemical recurrence (BCR) is an ominous finding and is associated with an increased risk of progression to metastatic disease, 6 it precedes clinical recurrence by many years.7-9 Furthermore, many patients with BCR will never progress.Currently, level 1 evidence suggests that adjuvant radiation should be administered to patients with high-risk prostate cancer following RP.10-13 However, adjuvant radiation has not been compared to early salvage radiation. [14][15][16] Therefore, most urologists would rather use early salvage therapy, most commonly offered after reaching BCR rather than after the first detectable PSA. 17 To the best of our knowledge, the time frame from the first detectable PSA to BCR has not been explored.In this study we used the 4 most accepted definitions for BCR: (1) PSA ≥0.2 ng/mL; (2) an initial PSA of ≥0.2 ng/mL and successive PSA ≥0.2 ng/mL; ...

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Risk of Prostate Cancer–Specific Mortality Following Biochemical Recurrence After Radical Prostatectomy

Cited by 1,238 publications

References 31 publications

Serum Total Testosterone Is a Significant Preoperative Variable Independently Contributing to Separating the Prostate Cancer Population into Prostatectomy Gleason Score Groups

Serum Total Testosterone Is a Significant Preoperative Variable Independently Contributing to Separating the Prostate Cancer Population into Prostatectomy Gleason Score Groups

Complications de l’hormonothérapie anti-androgénique du cancer de la prostate

Time from first detectable PSA following radical prostatectomy to biochemical recurrence: A competing risk analysis

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