PSA Kinetics and Risk Factors

Identify and closely monitor your patients at risk to help determine the onset of metastatic prostate cancer

Risk Factors for Prostate Cancer-Specific Mortality After Failure of Primary Therapy

After failure of primary therapy, any one of these independent risk factors can signal a patient at high risk for prostate cancer-specific mortality1:

  • Short time to biochemical recurrence
  • Rapid PSA-DT*
  • High Gleason score

*Prostate-specific antigen doubling time (PSA-DT) is the time it takes for a PSA value to double after PSA returns to measurable levels following primary therapy.

Together, these risk factors in patients with biochemical recurrence after radical prostatectomy (RP) can be a deadly combination1

128
128
128
Esimated 10-Year Risk After RP - Prostate Cancer Mortality

Adapted from Freedland SJ, et al. JAMA. 2005;294:433-439.

Objective

Define risk factors for prostate cancer-specific mortality (PCSM) following RP. Risk stratification tables for PCSM at 5, 10, and 15 years following biochemical recurrence after RP were developed.

Results

Patients who had the longest time to biochemical recurrence, lowest Gleason score, and longest PSA-DT were at lowest 10-year risk for PCSM.1

By contrast, the shortest time to biochemical recurrence, highest Gleason score, and shortest PSA-DT identified patients at highest 10-year risk.1

Study Design

A retrospective analysis of patients with Stage T1b-T3 prostate cancer who underwent RP at The Johns Hopkins Hospital was reported in 1999 by Pound et al (N=1997).2 In 2005, Freedland et al conducted a follow-up study, which included the patient subset from the earlier analysis (N=5096).1,2

  • 979 (19%) experienced biochemical recurrence1
    • 379 patients with biochemical recurrence and information on PSA-DT were used to estimate the risk of prostate cancer-specific mortality (PCSM)1
  • Patients did not receive adjuvant radiation or hormonal therapy prior to biochemical recurrence1
  • Follow up:
    • Median of 10 years following surgery1
    • Median of 6 years following biochemical recurrence1
  • 66 of 379 (17%) PCSMs1

There were wide confidence intervals around the estimates and some groups consisted of a small number of patients. This may limit the value of these data for prognostic purposes.1

The concordance index of this model using PDA-DT alone as a continuous variable to estimate time to PCSM was 0.83.1

Identify and closely monitor your patients at risk to help determine the onset of metastatic prostate cancer

What factors can signal increased risk of metastases after failure of primary therapy?

References:

  1. Freedland SJ, Humphreys EB, Mangold LA, et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005;294:433-439.
  2. Pound CR, Partin AW, Eisenberger MA, et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999;281:1591-1597.