Defining Biochemical Recurrence Of Prostate Cancer After Radical Prostatectomy: A Proposal For A Standardized Definition

UroToday.com - While an increasing PSA level is an early sign of prostate cancer (CaP) recurrence, varied definitions of biochemical recurrence (BCR) result in differing reports of disease progression rates. In the August 20, 2006 issue of the Journal of Clinical Oncology, Dr. Stephenson and associates at Memorial Sloan-Kettering Cancer Center propose a new, standardized definition of BCR.

The authors point out that a standardized BCR definition is important to demonstrate that the CaP recurrence is associated with a high likelihood of metastatic progression (MP) or prostate cancer-specific mortality (PCSM). To further evaluate this, they identified the PSA criterion, among 10 BCR definitions that best explained MP after radical prostatectomy (RP). They controlled for all prognostic variables and the use of secondary therapies.

Between 1985 and 2004 3,125 patients who had clinically localized CaP and underwent RP were analyzed. Those who had prior radiotherapy or androgen-deprivation therapy (ADT) were excluded. A median of 7 follow-up PSA levels was available per patient. Overall, 156 patients received radiotherapy and 225 patients received postoperative ADT as adjuvant or salvage therapy. Metastatic progression occurred in 75 patients at a median follow-up of 49 months. The study evaluated 10 different definitions of BCR, to include the ASTRO definition. PSA backdating was not performed for the other definitions.

Depending on the BCR definition applied, the number of recurrences ranged from 318 to 557 and the 10-year progression free probability ranged from 63% to 79%. In 8 of 10 definitions, the median time to recurrence ranged form 20-31 months, with the ASTRO definition being 15 months.

BCR when defined as a PSA of at least 0.4ng/ml and rising had the highest calculated R2 statistic. The data suggested that definitions that incorporated rising PSA values of at least 0.2ng/ml, or single PSA levels of at least 0.4ng/ml were the best predictors of MP and those that did not specify rising PSA values of at least 0.2ng/ml were the worst predictors. Recurrence defined as a single PSA of at least 0.2ng/ml or PSA of at least 0.1ng/ml and rising is of questionable clinical significance according to the researchers, as one-third of these patients followed for 4 years did not demonstrate a continued PSA rise. BCR defined as 3 successive rises of at least 0.1 was associated with a high probability of secondary therapy, but was among the definitions that predicted most poorly for MP.

In summary, BCR defined as a PSA of at least 0.4ng/ml followed by another increase was most associated with MP.

Andrew J. Stephenson, Michael W. Kattan, James A. Eastham, Zohar A. Dotan, Fernando J. Bianco, Jr, Hans Lilja, and Peter T. Scardino
J Clin Oncol 2006;224(24):3973-78

Reviewed By UroToday.com Contributing Editor Christopher P. Evans, M.D.

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