The risk for biochemical recurrence of prostate cancer remains relatively high even 10 years after radical prostatectomy, but it does not appear to be influenced by a positive family history of prostate cancer or a family or personal history of other cancer, according to a study analyzing data from the prospective German Familial Prostate Cancer database.
San Diego-The risk for biochemical recurrence (BCR) of prostate cancer remains relatively high even 10 years after radical prostatectomy, but it does not appear to be influenced by a positive family history of prostate cancer or a family or personal history of other cancer, according to a study analyzing data from the prospective German Familial Prostate Cancer database.
The research was presented by Kathleen Herkommer, MD, MBA, at the 2016 AUA annual meeting in San Diego and was subsequently published in the Journal of Urology (2017; 197:143-8).
The study included data from 10,310 patients who underwent radical prostatectomy without neoadjuvant or adjuvant therapy between 1979 and 2015, including 2,480 patients whose postoperative PSA remained undetectable during more than 10 years of follow-up (median, 12.8 years). Two hundred forty-nine of the latter patients eventually developed late BCR defined as PSA ≥0.2 ng/mL.
Commentary: When is a patient cured after prostatectomy?
A multiple proportional hazards regression with forward selection was conducted to determine independent predictors of late BCR (PSA ≥0.2 ng/mL). Consistent with previous reports, it identified pathologic Gleason score (categorical 2-6 vs. 7, 7 [3+4], 7 [4+3], 8-10, p=.002) and pathologic tumor stage (≥pT3a vs. ≤pT2c: HR: 1.50, p=.065). A number of other clinicopathologic, cancer history, and sociodemographic variables were analyzed, but the only other significant prognostic factors were age at surgery (HR per year: 1.04, p=.027) and PSA at diagnosis (HR: 1.02 per ng/mL, p=.020).
“Some patients whose PSA level remains undetectable 10 years after surgery ask, ‘What is my risk for prostate cancer recurrence?’, and patients with a positive family history of prostate cancer are particularly concerned,” said Dr. Herkommer, professor of urology, Technical University of Munich.
“In our population, one in every ten patients is at risk for late BCR, and because all of the men were identified by annual PSA measurement, we recommend that PSA testing continue beyond 10 years of follow-up. However, patients with a positive first-degree or hereditary family history of prostate cancer can be reassured that they are not at increased risk for recurrence of their prostate cancer.”
By Kaplan-Meier analysis, the estimated BCR rate was 34.3% at 10 years, 44.0% at 15 years, and 52.7% at 20 years.
Comparisons between the overall population and the patients with undetectable PSA for >10 years showed the latter subgroup had lower percentages of men with pathologic tumor stage ≥T3a, pathologic node stage N1, and pathologic Gleason score 8-10 and higher percentages with a family history of prostate cancer, family history of other cancer, and personal history of other cancer.
In addition, the median age at time of surgery was slightly younger in the men with undetectable PSA for >10 years compared with the overall population (63.3 vs. 64.6 years), and a higher percentage of men with undetectable PSA for >10 years were diagnosed before age 55 (10.0% vs. 9.1%). There were no differences between groups in comparisons of surgical margin status, mode of inheritance, marital status, region of residence, or financial situation between groups.
In univariate analysis, only PSA level at diagnosis, pathologic tumor stage, pathologic Gleason score, and age at surgery were associated with late BCR.
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