Natural History of Progression After PSA Elevation Following Radical Prostatectomy

Limitations of Prostate Specific Antigen Doubling Time Following Biochemical Recurrence After Radical Prostatectomy: Results From the SEARCH Database

“…Indeed, in prior studies, many patients did not have calculable PSADT. 1,3 Not only does this suggest a need for alternative prognostic markers in recurrent prostate cancer, but raises the possibility of selection bias between patients with and without calculable PSADT.…”

“…However, the clinical and pathological variables we used have been previously shown to correlate with time to metastases and prostate cancer specific mortality. 3,19 In addition, our data are integrated from multiple surgical centers. While this has the potential to introduce heterogeneity, we feel it is more illustrative of the real world differences that exist between centers in use of secondary therapies and thus the proportion of men in whom a PSADT is calculable.…”

“…In prior studies of men with biochemical recurrence after primary therapy, many patients did not have calculable PSADT. 1,3 Not only does this highlight the need for alternative prognostic markers for patients with recurrent prostate cancer, this raises the possibility that by limiting analyses to patients with calculable PSADT it may introduce selection bias. Moreover, as evidence grows to support additional therapies for high-risk cases, more patients will receive earlier treatment and even fewer patients will have calculable PSADT in the future.…”

The Natural History of Men Treated With Deferred Androgen Deprivation Therapy in Whom Metastatic Prostate Cancer Developed Following Radical Prostatectomy

“…17 The survival of contemporary patients with stage D2 CaP is markedly different from those of the prePSA and early PSA periods. This is due in large part to lead time bias from earlier detection of CaP.The first outcomes data for men with metastasis after RP were published by Pound et al 5 In a subset of 103 men with metastasis after RP from 1982 to 1997 there were 44 men who died of CaP. Analysis revealed that time from surgery to the development of metastasis was the only significant independent risk factor for PCSM.…”

“…[1][2][3] As our experience with treating men with RP has increased, we have also learned that many men who are not cured by surgery still may have good outcomes even when evidence of increasing PSA develops. [4][5][6] Androgen signaling events have for many years been known to control CaP cell growth and differentiation, and androgen deprivation therapy has long been a mainstay for the treatment of advanced CaP. 7,8 In the last several years the pattern of practice of ADT for CaP in most of the Western world has been characterized by implementation of treatment before evidence of metastasis.…”