Stratification of patient risk based on prostate-specific antigen doubling time after radical retropubic prostatectomy

Matthew K. Tollefson, Jeffrey M. Slezak, Bradley C. Leibovich, Horst Zincke, Michael L. Blute

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

OBJECTIVES: To assess the risk of local recurrence, systemic progression, and death from cancer among patients who experience biochemical relapse after radical retropubic prostatectomy and to stratify those patients by prostate-specific antigen (PSA) doubling time (DT). PATIENTS AND METHODS: We identified patients who experienced biochemical recurrence (defined as a PSA level ≥0.4 ng/mL) after radical prostatectomy from January 1, 1990, to December 31, 1339, for prostate adenocarcinoma. The PSA-DT was calculated by log linear regression using all PSA values within 2 years of biochemical recurrence. Local recurrence- and systemic progression-free survival and cancer-specific survival were estimated using the Kaplan-Meler method and analyzed by the log-rank test and Cox models. RESULTS: Biochemical recurrence was noted in 1521 (27%) of 5533 men during the follow-up period. Of the 1064 patients with a calculable PSA-DT, 322 (30%) had a PSA-DT of less than 1 year, 357 (34%) had a PSA-DT of 1 to 9.9 years, and 385 (36%) had a PSA-DT of 10 years or more. Patients with a PSA-DT of 10 years or more were less likely to have a higher preoperative PSA level, Gleason score, advanced pathologic stage, and seminal vesicle invasion. Patients with a PSA-DT of 10 years or more were at low risk of local recurrence (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.06-0.14; compared with patients with a PSA-DT of <1 year), systemic progression (HR, 0.05; 95% CI, 0.02-0.13), or death from cancer (HR, 0.15; 95% CI, 0.05-0.43). CONCLUSIONS: Prostate-specific antigen DT is an independent predictor of clinical disease recurrence and mortality after surgical biochemical failure. Risk stratification into high-, intermediate-, and low-risk categories based on the PSA-DT provides helpful clinical information and assists in the development of salvage therapy trials.

Original languageEnglish (US)
Pages (from-to)422-427
Number of pages6
JournalMayo Clinic Proceedings
Volume82
Issue number4
DOIs
StatePublished - 2007

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Prostate-Specific Antigen
Prostatectomy
Recurrence
Confidence Intervals
Salvage Therapy
Neoplasms
Neoplasm Grading
Seminal Vesicles
Proportional Hazards Models
Disease-Free Survival
Prostate
Linear Models
Adenocarcinoma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stratification of patient risk based on prostate-specific antigen doubling time after radical retropubic prostatectomy. / Tollefson, Matthew K.; Slezak, Jeffrey M.; Leibovich, Bradley C.; Zincke, Horst; Blute, Michael L.

In: Mayo Clinic Proceedings, Vol. 82, No. 4, 2007, p. 422-427.

Research output: Contribution to journalArticle

Tollefson, Matthew K. ; Slezak, Jeffrey M. ; Leibovich, Bradley C. ; Zincke, Horst ; Blute, Michael L. / Stratification of patient risk based on prostate-specific antigen doubling time after radical retropubic prostatectomy. In: Mayo Clinic Proceedings. 2007 ; Vol. 82, No. 4. pp. 422-427.
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abstract = "OBJECTIVES: To assess the risk of local recurrence, systemic progression, and death from cancer among patients who experience biochemical relapse after radical retropubic prostatectomy and to stratify those patients by prostate-specific antigen (PSA) doubling time (DT). PATIENTS AND METHODS: We identified patients who experienced biochemical recurrence (defined as a PSA level ≥0.4 ng/mL) after radical prostatectomy from January 1, 1990, to December 31, 1339, for prostate adenocarcinoma. The PSA-DT was calculated by log linear regression using all PSA values within 2 years of biochemical recurrence. Local recurrence- and systemic progression-free survival and cancer-specific survival were estimated using the Kaplan-Meler method and analyzed by the log-rank test and Cox models. RESULTS: Biochemical recurrence was noted in 1521 (27{\%}) of 5533 men during the follow-up period. Of the 1064 patients with a calculable PSA-DT, 322 (30{\%}) had a PSA-DT of less than 1 year, 357 (34{\%}) had a PSA-DT of 1 to 9.9 years, and 385 (36{\%}) had a PSA-DT of 10 years or more. Patients with a PSA-DT of 10 years or more were less likely to have a higher preoperative PSA level, Gleason score, advanced pathologic stage, and seminal vesicle invasion. Patients with a PSA-DT of 10 years or more were at low risk of local recurrence (hazard ratio [HR], 0.09; 95{\%} confidence interval [CI], 0.06-0.14; compared with patients with a PSA-DT of <1 year), systemic progression (HR, 0.05; 95{\%} CI, 0.02-0.13), or death from cancer (HR, 0.15; 95{\%} CI, 0.05-0.43). CONCLUSIONS: Prostate-specific antigen DT is an independent predictor of clinical disease recurrence and mortality after surgical biochemical failure. Risk stratification into high-, intermediate-, and low-risk categories based on the PSA-DT provides helpful clinical information and assists in the development of salvage therapy trials.",
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AU - Blute, Michael L.

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N2 - OBJECTIVES: To assess the risk of local recurrence, systemic progression, and death from cancer among patients who experience biochemical relapse after radical retropubic prostatectomy and to stratify those patients by prostate-specific antigen (PSA) doubling time (DT). PATIENTS AND METHODS: We identified patients who experienced biochemical recurrence (defined as a PSA level ≥0.4 ng/mL) after radical prostatectomy from January 1, 1990, to December 31, 1339, for prostate adenocarcinoma. The PSA-DT was calculated by log linear regression using all PSA values within 2 years of biochemical recurrence. Local recurrence- and systemic progression-free survival and cancer-specific survival were estimated using the Kaplan-Meler method and analyzed by the log-rank test and Cox models. RESULTS: Biochemical recurrence was noted in 1521 (27%) of 5533 men during the follow-up period. Of the 1064 patients with a calculable PSA-DT, 322 (30%) had a PSA-DT of less than 1 year, 357 (34%) had a PSA-DT of 1 to 9.9 years, and 385 (36%) had a PSA-DT of 10 years or more. Patients with a PSA-DT of 10 years or more were less likely to have a higher preoperative PSA level, Gleason score, advanced pathologic stage, and seminal vesicle invasion. Patients with a PSA-DT of 10 years or more were at low risk of local recurrence (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.06-0.14; compared with patients with a PSA-DT of <1 year), systemic progression (HR, 0.05; 95% CI, 0.02-0.13), or death from cancer (HR, 0.15; 95% CI, 0.05-0.43). CONCLUSIONS: Prostate-specific antigen DT is an independent predictor of clinical disease recurrence and mortality after surgical biochemical failure. Risk stratification into high-, intermediate-, and low-risk categories based on the PSA-DT provides helpful clinical information and assists in the development of salvage therapy trials.

AB - OBJECTIVES: To assess the risk of local recurrence, systemic progression, and death from cancer among patients who experience biochemical relapse after radical retropubic prostatectomy and to stratify those patients by prostate-specific antigen (PSA) doubling time (DT). PATIENTS AND METHODS: We identified patients who experienced biochemical recurrence (defined as a PSA level ≥0.4 ng/mL) after radical prostatectomy from January 1, 1990, to December 31, 1339, for prostate adenocarcinoma. The PSA-DT was calculated by log linear regression using all PSA values within 2 years of biochemical recurrence. Local recurrence- and systemic progression-free survival and cancer-specific survival were estimated using the Kaplan-Meler method and analyzed by the log-rank test and Cox models. RESULTS: Biochemical recurrence was noted in 1521 (27%) of 5533 men during the follow-up period. Of the 1064 patients with a calculable PSA-DT, 322 (30%) had a PSA-DT of less than 1 year, 357 (34%) had a PSA-DT of 1 to 9.9 years, and 385 (36%) had a PSA-DT of 10 years or more. Patients with a PSA-DT of 10 years or more were less likely to have a higher preoperative PSA level, Gleason score, advanced pathologic stage, and seminal vesicle invasion. Patients with a PSA-DT of 10 years or more were at low risk of local recurrence (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.06-0.14; compared with patients with a PSA-DT of <1 year), systemic progression (HR, 0.05; 95% CI, 0.02-0.13), or death from cancer (HR, 0.15; 95% CI, 0.05-0.43). CONCLUSIONS: Prostate-specific antigen DT is an independent predictor of clinical disease recurrence and mortality after surgical biochemical failure. Risk stratification into high-, intermediate-, and low-risk categories based on the PSA-DT provides helpful clinical information and assists in the development of salvage therapy trials.

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