PSA Doubling Time and Absolute PSA Predict Metastasis-free Survival in Men With Biochemically Recurrent Prostate Cancer After Radical Prostatectomy.

Abstract

The aim of this study was to investigate the association of prostate-specific antigen (PSA) values on metastasis-free survival (MFS) in men with biochemically recurrent prostate cancer (BRPC) and PSA doubling time (PSADT)< 12 months. This datasetalso reflects an update with longer follow-up of our prior publications on the natural history of BRPC in the absence of treatment. In this report, we combined databases from the Center for Prostate Disease Research and Johns Hopkins University (CPDR/JHU). In the CPDR/JHU radical prostatectomy database (30,936 total patients), 656 men with BRPC (> 0.2 ng/mL) after prostatectomy and PSADT<12 months, who received no adjuvant/salvage androgen deprivation and/or radiation therapy, were prospectively followed until radiologic evidence of metastasis and are included in this analysis. Metastasis occurred in 250 of 656 patients with BRPC (median follow-up, 5 years). PSADT< 7.5 months and Gleason score were independent risk factors for distant metastasis in multivariable analysis. Risk of metastasis increased for PSADT 6.01 to 7.50, 4.51 to 6.0, 3.01 to 4.50, and≤ 3.0 months, after adjusting for Gleason score. A PSA value≥ 0.5 ng/mL significantly and independently increased risk of metastasis in patients with PSADT< 12 months (hazard ratio, 2.79; 95% confidence interval, 1.47-5.29; P= .001). In men with PSADT< 12 months, PSADT≤ 7.5 months, PSA≥ 0.5 ng/mL, and Gleason score are independent predictors of MFS on multivariable analysis.