Predicting prostate cancer specific mortality following biochemical recurrence after radical prostatectomy

Abstract

4546 Background: The natural history of biochemical recurrence (BCR) after radical prostatectomy (RP) can be long, but variable. Better predictive models are needed to identify men early who are at high-risk for CaP death for aggressive salvage treatment as well as to identify men who are at low-risk for CaP death and can be safely observed. We sought to define risk factors for CaP specific mortality following RP and develop tables to risk stratify for CaP specific survival. Methods: We retrospectively studied 5,096 patients treated with RP between 1982 and 2000 of which 379 experienced a BCR and had at least 2 PSA values available after BCR separated by at least 3 months in order to calculate a PSA doubling time (PSADT). Multivariable Cox proportional hazards analysis was used to determine the significant predictors of CaP specific mortality. Results: With a median follow-up of 10.3 yrs after BCR (range 1–16 yrs) the CaP specific survival was 55%. On multivariable analysis, pathological Gleason sum (p=0.002), time from RP to BCR (p=0.02), and PSADT as a continuous variable (p<0.001) were all significant independent predictors of time to CaP death. Using these three variables, the 5-, 10-, and 15-year risk of CaP specific survival can be estimated. The 15-year risk of CaP specific survival is shown in the table. Conclusions: Clinical parameters (PSADT, pathological Gleason sum, and time from RP to BCR) can help risk stratify patients for CaP death following BCR after RP. No significant financial relationships to disclose.