Long‐term overall survival and metastasis‐free survival for men with prostate‐specific antigen‐recurrent prostate cancer after prostatectomy: analysis of the Center for Prostate Disease Research National Database

Antonarakis, Emmanuel S.; Chen, Yongmei; Elsamanoudi, Sally; Brassell, Stephen A.; Rocha, Mario V. Da; Eisenberger, Mario A.; McLeod, David G.

doi:10.1111/j.1464-410x.2010.09878.x

Cited by 77 publications

(71 citation statements)

References 34 publications

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“…Of this population, 346 men had OS data available. Patients with PSA doubling time (DT) G3 months had 27-fold higher risk of metastasis and 8-fold increased risk of death than men with PSADT 99 months [39]. In an updated report [40•] from this study including 1973 men, of which 450 patients had BCRPC with available data, they were able to show that PSADT and Gleason score were independent risk factors predictive of MFS.…”

Section: Timing Of Adtmentioning

confidence: 87%

Management Options for Biochemically Recurrent Prostate Cancer

Fakhrejahani

Madan

Dahut

2017

Curr. Treat. Options in Oncol.

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Prostate cancer is the most common solid tumor malignancy in men worldwide. Treatment with surgery and radiation can be curative in organ-confined disease. Unfortunately, about one third of men develop biochemically recurrent disease based only on rising prostate-specific antigen (PSA) in the absence of visible disease on conventional imaging. For these patients with biochemical recurrent prostate cancer, there is no uniform guideline for subsequent management. Based on available data, it seems prudent that biochemical recurrent prostate cancer should initially be evaluated for salvage radiation or prostatectomy, with curative intent. In selected cases, high-intensity focused ultrasound and cryotherapy may be considered in patients that meet very narrow criteria as defined by non-randomized trials. If salvage options are not practical or unsuccessful, androgen deprivation therapy (ADT) is a standard option for disease control. While some patients prefer ADT to manage the disease immediately, others defer treatment because of the associated toxicity. In the absence of definitive randomized data, patients may be followed using PSA doubling time as a trigger to initiate ADT. Based on retrospective data, a PSA doubling time of less than 3-6 months has been associated with near-term development of metastasis and thus could be used signal to initiate ADT. Once treatment is begun, patients and their providers can choose between an intermittent and continuous ADT strategy. The intermittent approach may limit side effects but in patients with metastatic disease studies could not exclude a 20% greater risk of death. In men with biochemical recurrence, large studies have shown that intermittent therapy is non-inferior to continuous therapy, thus making this a reasonable option. Since biochemically recurrent prostate cancer is defined by technological limitations of radiographic detection, as new imaging (i.e., PSMA) strategies are developed, it may alter how the disease is monitored and perhaps managed. Furthermore, patients have no symptoms related to their disease and thus many prefer options that minimize toxicity. For this reason, herbal agents and immunotherapy are under investigation as potential alternatives to ADT and its accompanying side effects. New therapeutic options combined with improved imaging to evaluate the disease may markedly change how biochemically recurrent prostate cancer is managed in the future.

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Section: Timing Of Adtmentioning

confidence: 87%

Management Options for Biochemically Recurrent Prostate Cancer

Fakhrejahani

Madan

Dahut

2017

Curr. Treat. Options in Oncol.

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“…PSADT, together with time to PSA recurrence, have been shown to be significant predictors of prostate cancer-specific mortality (2,26). If our findings regarding sensitivity and specificity of 2pPSA are confirmed in other series, it would be of note to explore whether the kinetics of 2pPSA are likely to add prognostic information in patients with biochemical recurrence following prostate cancer surgery.…”

Section: Testmentioning

confidence: 64%

“…A persistently elevated or rising serum level of PSA following radical prostatectomy universally antedates metastatic progression and prostate cancer-specific mortality, but it is not a surrogate for these endpoints (2,17). This condition indicates a heterogeneous patient population in which the prognosis is highly variable and the management of patients is controversial.…”

Section: Discussionmentioning

confidence: 99%

A pilot study evaluating serum pro-prostate-specific antigen in patients with rising PSA following radical prostatectomy

et al. 2012

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Abstract. [-2]pro-prostate-specific antigen (2pPSA), a proform of PSA, is a new marker in patients at risk of prostate cancer. We explored the potential role of 2pPSA in the identification of patients with metastatic progression following radical prostatectomy for prostate cancer. Seventy-six patients with biochemical (PSA) recurrence following radical prostatectomy were studied retrospectively. Diagnostic imaging performed at the time of biochemical recurrence confirmed metastatic disease in 31 of the 76 patients. Serum samples were collected and stored at the time of imaging-confirmed metastatic progression or at the most recent procedure for patients with negative imaging. Median values of PSA, free PSA (fPSA), %fPSA, 2pPSA and prostate health index (PHI) were compared between metastatic and non-metastatic patients by the Mann-Whitney U test. The results of each test were then correlated with metastatic status by univariate and multivariate logistic regression analysis. PSA, fPSA, %fPSA, 2pPSA serum concentrations and PHI values were statistically significantly higher in patients with metastatic disease. Results of the multivariate analysis revealed that 2pPSA remained a statistically significant predictor of imaging-proven metastatic prostate cancer among patients with biochemical recurrence. At a cut-off value of 12.25 pg/ml, 2pPSA outperformed the other markers in terms of sensitivity and specificity (97 and 80%, respectively) with respect to imaging-confirmed metastatic progression. This is the first study suggesting that 2pPSA predicts diagnostic imaging-proven metastatic disease in previously resected prostate cancer patients with biochemical recurrence. Our results merit validation in a prospective study.

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“…43 An updated analysis of this same cohort with a longer follow-up established that the median metastasis-free survival in men with biochemically recurrent prostate cancer after prostatectomy was 10 years, even in the absence of salvage radiation or hormonal therapies. 44 This prolonged time to metastatic progression has been confirmed in an independent patient population, 45 and suggests that only patients with high-risk features (Gleason score .7, PSA doubling time f9 months) should be treated with immediate ADT in this setting.…”

Section: Biochemical Progressionmentioning

confidence: 76%