PSA-recurrence after radical prostatectomy for intermediate/high risk prostate cancer: A helpful parameter or just a patient stress amplifier.

Abstract

e16535 Background: Development of biochemical recurrence with a rising PSA level after radical prostatectomy causes significant anxiety for patients and treating oncologist. Management of these patients is controversial. Here, we characterize the natural course and pattern of disease progression and survival in men with biochemical recurrence (BCR) after radical prostatectomy (RP) for intermediate and high-risk prostate cancer (PCa) untreated until clinical failure (CF). Methods: Retrospective analysis of consecutive men with BCR after RP for intermediate/high risk PCa. All patients underwent RP+extended pelvic lymph node dissection. A PSA level > 0.2 ng/ml on two consecutive measures was considered BCR. None received neoadjuvant or adjuvant therapy prior to documented clinical failure by body imaging, which was performed at the time point of BCR or symptoms and at least once per year. Results: Of the 622 men with BCR included into the analysis, 267 (43%) had high risk PCa. Median follow-up after RP was 9.4 yrs. (IQR 4.8-15.1) and median time from RP to BCR was 1.4 yrs. (IQR 0.4-3.6). Of the patients 324 (52%) never experienced CF (Æfollow-up from BCR 5.8yr, IQR2.1-11.9); 88 (14%) had local recurrence only; 59 (9%) had lymph node metastasis +/-local recurrence and 151(24%) distant metastasis. The median times from BCR to CF were: 9.5 yrs. (IQR 5.6-13.5) for local failure; 4.9 yrs. (IQR 3.1-8.8) for lymph node failure and 5.6 yrs. (IQR 3-10.5) for distant failure. The 10-yrs cancer specific (CSS) and overall survival (OS) of the entire group from time point of BCR was 78% and 66%, respectively. 5- and 7-yrs conditional CSS from time of CF was strongly depended on recurrence pattern and ranged from 90% and 79% (local only) to 70% and 47% (lymph node+/-local) and 47% and 36% (distant mets), respectively. PSA-doubling time < 12 months and > 2 positive nodes were independent predictors of outcome in multivariate analysis. Conclusions: These data may be useful in informing men with intermediate/high risk PCa regarding the natural course of PSA recurrence and counseling the timing of additional therapies.