Prostate specific antigen doubling time (PSADT) predicts for distant failure and prostate cancer specific survival (PCSS) in men with biochemical relapse after radical prostatectomy (RP)

Abstract

4555 Background: Patients (pts) with biochemical (PSA) relapse after RP represent a rapidly rising population in whom appropriate standards of care remain undefined. Over the past several years we have focused on studying the natural history of these pts. Our previous report (Pound et al; JAMA 1999) suggests that the Gleason score, time of PSA relapse (>0.2 ng/ml) and PSADT are the strongest predictors of the probability of distant metastasis (DM) (Cox model). A recent update (Partin; AUA 2003, Eisenberger; ASCO 2003) suggests that PSADT overrides the other parameters in the prediction of DM. Our experience has been expanded (> 1000 additional pts and longer follow-up). We evaluate the relationship between PSADT and PCSS. Methods: 4,415 pts underwent a RP from 1982–2003 and 825 demonstrated evidence of PSA relapse. All pts were followed with yearly PSAs with no androgen deprivation given until development of DM. Cox-proportional hazards and Kaplan-Meier survival analyses were completed with time from PSA relapse to censoring (last follow-up) or death used as endpoint. Results: 825/4,415 demonstrated PSA relapse (mean time 8.4yrs), 170/825(20.6%) developed DM and 109/825(13%) have died of prostate cancer (PCa). PSADT was calculated on 411 pts (mean 9 PSAs /pt, range 2–33), ROC-AUC for PSADT prediction of PCSS was 0.77. Conclusions: PSADT is a potent predictor of the probability of DM and PCSS. Pts with PSADT ≤10 mos. are at significant risk for developing DM and dying of PCa. In this group, clinical trials should evaluate progression-free and overall survival with aggressive approaches. Pts with PSADT of >10 mos. may be observed or treated to delay onset of DM. (Supported by CAPCURE). No significant financial relationships to disclose.