Fewer than 20% of patients with biochemical recurrence after radical prostatectomy develop metastasis, and a smaller proportion die as a result of prostate cancer.
Hamburg, Germany-Fewer than 20% of patients with biochemical recurrence after radical prostatectomy (RP) develop metastasis, and a smaller proportion die as a result of prostate cancer.
A retrospective analysis of more than 4,000 men undergoing RP also identified a shorter time to biochemical recurrence as a predictor of metastatic disease, German researchers reported at the AUA annual meeting in San Diego.
Not all patients with biochemical recurrence after RP progress to systemic disease or cancer-specific death. Recent studies show similar survival rates for patients with and without biochemical recurrence at 10 years.
Lead investigator Raisa Pompe, MD, assistant professor of oncology at the University Medical Center Hamburg-Eppendorf in Hamburg, and co-investigators sought to analyze the long-term oncologic outcomes in a large German cohort of patients with biochemical recurrence and to identify predictors of metastasis and prostate cancer death in these men.
To accomplish this goal, they assessed data from 4,754 men who underwent RP between 1992 and 2005 at Martini-Klinik, Hamburg. Included were patients with biochemical recurrence defined as a serum PSA level ≥0.2 ng/mL on two consecutive measurements. Patients who received neoadjuvant or adjuvant treatment were excluded. Univariate and multivariate regression analyses were performed to identify predictors of oncologic outcomes.
In the database, 1,189 had biochemical recurrence within a median follow-up of 132.6 months. The median time to biochemical recurrence was 37.9 months. About 60% of these patients had extraprostatic disease, about 80% had a Gleason score ≥6, 5% had a Gleason score ≥8, and 35% had positive surgical margins.
Of the 1,189 patients with biochemical recurrence, 15.9% developed metastatic disease and 11.1% died from prostate cancer.
“We found a 10-year metastasis-free survival of 87.1% and a 10-year cancer-specific survival rate of 90.8%,” Dr. Pompe said. The 10-year overall survival rate was 85.9%.
Univariate analysis showed the worst metastasis-free survival and cancer-specific survival in the group that experienced biochemical recurrence within 12 months after surgery.
Next: Higher Gleason score among predictors
On multivariable Cox regression analysis, a short time from surgery to biochemical recurrence was an independent risk factor for metastatic disease (p=.01), as well as a higher Gleason score (p=.0033), a positive surgical margin (p=.0151), receipt of salvage radiation therapy (p<.001), and receipt of androgen deprivation therapy (ADT) (p<.001).
Independent predictors of cancer-specific death were shorter time from surgery to biochemical recurrence (p<.001), higher Gleason score (p=.0001), and receipt of ADT (p<.0001).
PSA doubling time was not included in the regression model but the investigators hope to include it in the final analysis, said Dr. Pompe.
“Over 10 years of the observation period, there have been a lot of changes in surgical and pathological techniques, and there are some more systemic therapies available right now for metastases and metastatic castrate-resistant prostate cancer; for example abiraterone [ZYTIGA] and enzalutamide [XTANDI],” she said.
The findings may be beneficial for counseling of patients regarding salvage treatments, she said.
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