Type of patients in whom biochemical recurrence after radical prostatectomy can be observed without salvage therapy.

Abstract

PURPOSE:

To examine the prognosis after BCR with and without salvage therapy, including radiation and/or androgen deprivation.

METHODS:

The study population consisted of 431 patients, all of whom underwent radical prostatectomy and developed BCR (PSA > 0.2 ng/mL). According to the two risk factors [Gleason score ≥ 8 and PSA-doubling time (DT) < 6 months], we divided the patients into two groups. The high/intermediate-risk group consisted of patients with both or one risk factor. On the other hand, patients with neither factor were in the low-risk group. We set the starting point at the timing of BCR, and the endpoints were development to castration-resistant prostate cancer (CRPC) and cancer-specific death.

RESULTS:

During the mean follow-up period of 8.3 years after BCR, CRPC was observed in 49 patients (11.4%), and 21 patients (4.9%) died due to prostate cancer. We first divided the 191 high/intermediate-risk patients according to the PSA level (PSA < 1.0 ng/mL, PSA 1.0-4.0, and PSA > 4.0 or no therapy) at the initiation of salvage therapy, including radiation and/or androgen deprivation. We found that delayed (PSA > 4.0 ng/mL) or no salvage therapy was significantly associated with CRPC and cancer-specific death. In the 240 low-risk patients, Kaplan-Meier curves demonstrated no significant difference in CRPC-free survival or cancer-specific survival within 10 years from the timing of BCR.

CONCLUSIONS:

Observation after BCR without salvage therapy or delayed administration may be an option for low-risk patients with a Gleason score ≤ 7 and PSA-DT ≥ 6 months when their life expectancy is within 10 years.

• Authors: Kazuhiro Matsumoto, Naoya Niwa, Masayuki Hagiwara, Takeo Kosaka, Nobuyuki Tanaka, Toshikazu Takeda, Shinya Morita, Ryuichi Mizuno, Toshiaki Shinojima, Satoshi Hara, Hiroshi Asanuma, Mototsugu Oya
• Journal: World journal of urology (World J Urol) Vol. 38 Issue 7 Pg. 1749-1756 (Jul 2020) ISSN: 1433-8726 [Electronic] Germany
• PMID: 31559475 (Publication Type: Journal Article)

Chemical References

• Androgen Antagonists
• Prostate-Specific Antigen

Topics

• Aged
• Androgen Antagonists (therapeutic use)
• Combined Modality Therapy
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (blood, therapy)
• Prognosis
• Prostate-Specific Antigen (blood)
• Prostatectomy
• Prostatic Neoplasms (blood, classification, surgery, therapy)
• Retrospective Studies
• Risk Factors
• Salvage Therapy