MP78-15 PSA DOUBLING TIME FOLLOWING RADICAL PROSTATECTOMY: LONG TERM ANALYSIS OF LINEAR (VERSUS GEOMETRIC) PROGRESSION.

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You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History III1 Apr 2014MP78-15 PSA DOUBLING TIME FOLLOWING RADICAL PROSTATECTOMY: LONG TERM ANALYSIS OF LINEAR (VERSUS GEOMETRIC) PROGRESSION. Blanca Morales, Douglas Skarecky, and Thomas Ahlering Blanca MoralesBlanca Morales More articles by this author , Douglas SkareckyDouglas Skarecky More articles by this author , and Thomas AhleringThomas Ahlering More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2498AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studies support the prognostic impact of geometric progression of PSA via doubling times (PSAdt). Geometric BCR represents “malignant” progression whereas linear progression theoretically has “benign” implications. In this observational study we analyze a group of (untreated) men with BCR whose PSA progression appears linear with follow up >4 years. METHODS From 1300 consecutive men, 175 (13.5%) men had BCR defined by 2 or more PSA values >0.2 and/or secondary prostate cancer treatment (ie hormonal, radiation therapy). 7/175 were excluded due to incomplete data; 32/175 (18%) underwent adjunctive treatment due to high risk (pN2+, etc); of the remaining 137, 91/175 had salvage treatment due to geometric progression (mean 22 mos.). 45/175 (26%) are untreated and the study group consists of 32 with a minimum 4 years follow up: mean follow up 6.6 years (range 48-123 mos). We have developed an electronic calculator that simultaneously tracts PSA geometric progression (ln(2)/slope) as well as linear progression (PSA value/time). Best fit estimates for linear versus geometric progression was calculated by R2. RESULTS Table 1 depicts clinical and pathologic features between adjunctive, salvage and observation (untreated) groups. The immediate or adjunctive group in general had much higher clinical PSA values, Gleason scores and multiple lymph nodes positive. There were no significant differences in Gleason score, presence of surgical margin, pathological stage between the salvage and observed groups. We did note that 10 (11%) of the salvage group had been in the observation group for > 4 years. OBSERVATION GROUP. 32 or 18% of BCRs have been managed with observation without evidence of clinical/symptomatic recurrence. Two men however appear at clear risk of converting from linear to progression more the 48 months postop. Three men had 9 or more years of follow up. CONCLUSIONS We make the observation that ∼18% of men with BCR appear to have BCR that is linear in nature. In this group we have seen long term metastasis and clinical progression free outcomes. The PSA kinetics and our findings suggest that a substantial percent of BCR is “benign” in nature and presumably managed with observation reserving treatment for geometric progression. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e926 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Blanca Morales More articles by this author Douglas Skarecky More articles by this author Thomas Ahlering More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...