Natural history of progression after PSA elevation following radical prostatectomy

被引:2492
作者
Pound, CR
Partin, AW
Eisenberger, MA
Chan, DW
Pearson, JD
Walsh, PC
机构
[1] Johns Hopkins Med Inst, James Buchanan Brady Urol Inst, Dept Urol, Baltimore, MD 21205 USA
[2] Johns Hopkins Med Inst, Dept Oncol, Baltimore, MD 21205 USA
[3] Johns Hopkins Med Inst, Dept Pathol, Baltimore, MD 21205 USA
[4] Merck Res Labs, Dept Epidemiol, Blue Bell, PA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 1999年 / 281卷 / 17期
关键词
D O I
10.1001/jama.281.17.1591
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. Objective To characterize the time course of disease progression in men with biochemical recurrence after radical prostatectomy. Design A retrospective review of a large surgical series with median (SD) follow-up of 5.3 (3.7) years (range, 0.5-15 years) between April 1982 and April 1997, Setting An urban academic tertiary referral institution. Patients A total of 1997 men undergoing radical prostatectomy, by a single surgeon, for clinically localized prostate cancer. None received neoadjuvant therapy, and none had received adjuvant hormonal therapy prior to documented distant metastases. Main Outcome Measures After surgery, men were followed up with PSA assays and digital rectal examinations every 3 months for the first year, semiannually for the second year, and annually thereafter. A detectable serum PSA level of at least 0.2 ng/mL was evidence of biochemical recurrence. Distant metastases were diagnosed by radionuclide bone scan, chest radiograph, or other body imaging, which was performed at the time of biochemical recurrence and annually thereafter. Results The actuarial metastasis-free survival for all 1997 men was 82% (95% confidence interval, 76%-88%) at 15 years after surgery, Of the 1997 men, 315 (15%) developed biochemical PSA level elevation. Eleven of these underwent early hormone therapy after the recurrence and are not included in the study. Of the remaining 304 men, 103 (34%) developed metastatic disease within the study period. The median actuarial time to metastases was 8 years from the time of PSA level elevation. in survival analysis, time to biochemical progression (P<.001), Gleason score (P<.001), and PSA doubling time (P<.001) were predictive of the probability and time to the development of metastatic disease. An algorithm combining these parameters was constructed to stratify men into risk groups. Once men developed metastatic disease, the median actuarial time to death was 5 years. The time interval from surgery to the appearance of metastatic disease was predictive of time until death (P<.02). Conclusions Several clinical parameters help predict the outcomes of men with PSA elevation after radical prostatectomy. These data may be useful in the design of clinical trials, the identification of men for enrollment into experimental protocols, and counseling men regarding the timing of administration of adjuvant therapies.
引用
收藏
页码:1591 / 1597
页数:7
相关论文
共 35 条
[1]  
ADOLFSSON J, 1993, CANCER-AM CANCER SOC, V72, P310, DOI 10.1002/1097-0142(19930715)72:2<310::AID-CNCR2820720203>3.0.CO
[2]  
2-T
[3]  
Bauer JJ, 1997, CANCER, V79, P952, DOI 10.1002/(SICI)1097-0142(19970301)79:5<952::AID-CNCR12>3.3.CO
[4]  
2-I
[5]  
Byar D P, 1988, NCI Monogr, P165
[6]  
BYAR DP, 1973, CANCER, V32, P1126, DOI 10.1002/1097-0142(197311)32:5<1126::AID-CNCR2820320518>3.0.CO
[7]  
2-C
[8]   5-YEAR TUMOR RECURRENCE RATES AFTER ANATOMICAL RADICAL RETROPUBIC PROSTATECTOMY FOR PROSTATE-CANCER [J].
CATALONA, WJ ;
SMITH, DS .
JOURNAL OF UROLOGY, 1994, 152 (05) :1837-1842
[9]   A CONTROLLED TRIAL OF LEUPROLIDE WITH AND WITHOUT FLUTAMIDE IN PROSTATIC-CARCINOMA [J].
CRAWFORD, ED ;
EISENBERGER, MA ;
MCLEOD, DG ;
SPAULDING, JT ;
BENSON, R ;
DORR, FA ;
BLUMENSTEIN, BA ;
DAVIS, MA ;
GOODMAN, PJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 321 (07) :419-424
[10]   Hazard rates for progression after radical prostatectomy for clinically localized prostate cancer [J].
Dillioglugil, O ;
Leibman, BD ;
Kattan, MW ;
SealeHawkins, C ;
Wheeler, TM ;
Scardino, PT .
UROLOGY, 1997, 50 (01) :93-99