You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2014PD34-07 NATURAL HISTORY OF PROGRESSION TO PSA RECURRENCE AND METASASIS AMONG AT RISK MEN FOLLOWING RADICAL PROSTATECTOMY Ashley Ross, Mercedeh Ghadessi, Debasish Sundi, Misop Han, Elizabeth Humphreys, Elai Davicioni, Alan Partin, Patrick Walsh, and Edward Schaeffer Ashley RossAshley Ross More articles by this author , Mercedeh GhadessiMercedeh Ghadessi More articles by this author , Debasish SundiDebasish Sundi More articles by this author , Misop HanMisop Han More articles by this author , Elizabeth HumphreysElizabeth Humphreys More articles by this author , Elai DavicioniElai Davicioni More articles by this author , Alan PartinAlan Partin More articles by this author , Patrick WalshPatrick Walsh More articles by this author , and Edward SchaefferEdward Schaeffer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2432AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance for low- and very low- risk prostate cancer has been gaining acceptance with the aim of preferentially treating men with NCCN intermediate and high risk disease. Commonly used outcome estimates and nomograms however were developed considering complete surgical cohorts, which include a high proportion of men with low or very low- risk disease (and thus favorable long term outcomes). Here we describe the outcomes of men with intermediate and high risk prostate cancer treated only by radical prostatectomy (RP) until the time of metastasis. METHODS Men with prostate cancer who had no neo-adjuvant treatment and underwent RP in the PSA era were selected from Johns Hopkins Medical Institute (JHMI) database. NCCN intermediate and high-risk men who had initially undetectable PSAs after surgery and received no post-RP therapy prior to metastasis were included (1739 men). Biochemical recurrence (BCR) was defined by a PSA of ≥0.2 ng/ml and metastasis was diagnosed by axial imaging or bone scan. RESULTS Median follow up was 10 years and 17% developed BCR with a median time to BCR of 3 years (range 1-18). 41% of these men developed metastasis at a median time of 3 years (range 0-11) after BCR. Median time from metastasis to death was 4 years (range 0-11). Among variables available at the time of surgery, pathologic Gleason grade (≥ 7), extracapsular extension, lymph node status and seminal vesicle involvement were the most potent predictors of metastatic progression (p< 0.0001) having hazard ratios of 20.3, 3.5, 3.8 and 3.9, respectively. On average, men with metastasis had higher median CAPRA-S scores and Stephenson scores than those without metastatic progression (6 vs. 2 and 0.28 vs. 0.04, respectively p<0.001 for both) but the range of scores was broad (CAPRA-S of 1-12 vs. 0-10 and Stephenson of 0.02-0.95 vs. 0.01-0.71 for men with and without metastasis respectively). Following BCR, PSADT was overall the most potent predictor of metastatic disease and death with men having a PSADT <6 months having a 3.5 (p< 0.0001) and 3.0 (p=0.001) fold increased risk of metastatic and death from prostate cancer, respectively. CONCLUSIONS As practice patterns shift towards the treatment of higher risk localized disease, point estimates for the time to BCR, metastatic progression, and death shorten accordingly. In addition, the predictive ability of clinicopathologic variables and nomograms is diminished. This highlights the need for additional information (i.e. molecular markers) to help guide treatment decisions among at risk men following radical prostatectomy. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e898-e899 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ashley Ross More articles by this author Mercedeh Ghadessi More articles by this author Debasish Sundi More articles by this author Misop Han More articles by this author Elizabeth Humphreys More articles by this author Elai Davicioni More articles by this author Alan Partin More articles by this author Patrick Walsh More articles by this author Edward Schaeffer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...