Time Without PSA Recurrence After Radical Prostatectomy As a Predictor of Future Biochemical Recurrence, Metastatic Disease and Prostate Cancer Death: a Prospective Scandinavian Cohort Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2022 Dec 29

PMID 36581423

Authors

Mats Steinholtz Ahlberg

Hans Garmo

Hans-Olov Adami

Ove Andren

Jan-Erik Johansson

Gunnar Steineck

Lars Holmberg

Anna Bill-Axelson

Affiliations

Soon will be listed here.

Abstract

Objective: Although surveillance after radical prostatectomy routinely includes repeated prostate specific antigen (PSA)-testing for many years, biochemical recurrence often occurs without further clinical progression. We therefore hypothesised that follow-up can be shortened for many patients without increasing the risk of prostate cancer death. We investigated the long-term probabilities of PSA recurrence, metastases and prostate cancer death in patients without biochemical recurrence five and 10 years after radical prostatectomy.

Design: Prospective cohort study. Stratification by Gleason score (≤3+4=7 or ≥4+3=7), pathological tumour stage (pT2 or ≥pT3) and negative or positive surgical margins.

Setting: Between 1989 and 1998, 14 urological centres in Scandinavia randomised patients to the Scandinavian Prostate Cancer Group study number 4 (SPCG-4) trial.

Participation: All 306 patients from the SPCG-4 trial who underwent radical prostatectomy within 1 year from inclusion were eligible. Four patients were excluded due to surgery-related death (n=1) or salvage radiotherapy or hormonal treatment within 6 weeks from surgery (n=3).

Primary Outcome Measures: Cumulative incidences and absolute differences in metastatic disease and prostate cancer death.

Results: We analysed 302 patients with complete follow-up during a median of 24 years. Median preoperative PSA was 9.8 ng/mL and median age was 65 years. For patients without biochemical recurrence 5 years after radical prostatectomy the 20-year probability of biochemical recurrence was 25% among men with Gleason score ≤3+4=7 and 57% among men with Gleason score ≥4+3=7; the probabilities for metastases were 0.8% and 17%; and for prostate cancer death 0.8% and 12%, respectively. The long-term probabilities were higher for pT ≥3 versus pT2 and for positive versus negative surgical margins. Limitations include small size of the cohort.

Conclusion: Many patients with favourable histopathology without biochemical recurrence 5 years after radical prostatectomy could stop follow-up earlier than 10 years after radical prostatectomy.

Citing Articles

Organ-confined prostate cancer with negative surgical margins in an entirely-embedded radical prostatectomy is essentially non-lethal-a retrospective single-institutional study of 520 patients.

Luo W, Lammert S, Coukos J, Modi P, Antic T, Kwon J Int Urol Nephrol. 2024; 57(4):1105-1112.

PMID: 39576420 DOI: 10.1007/s11255-024-04296-y.

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