The Natural History Of Noncastrate Metastatic Prostate Cancer After Radical Prostatectomy

UroToday.com- Most patients with a rising PSA following relapse after primary therapy are treated with early androgen deprivation therapy (ADT). The natural history of these men therefore is not well defined. In the online version of European Urology, Dr. Yossepowitch and colleagues from Memorial Sloan-Kettering Cancer Center report that the median disease-specific survival from diagnosis of noncastrate metastases is 6.6 years.

The study cohort was comprised of 95 patients who developed metastatic disease without previously being treated by ADT for PSA relapse. Of these, 34 had received a short course of ADT before surgery, but testosterone was above castrate level at the time of metastatic presentation. Median follow-up was 7.1 years. Follow-up consisted of routine examinations, PSA testing, bone scans and additional imaging as indicated. At completion of follow-up, 33 men (35%) had died and in 29 of these the death was attributed to progressive castrate metastatic prostate cancer.

The mean interval from surgery to first evidence of metastatic disease was 4.2 years. Median PSA level at initial noncastrate metastasis was 13.5ng/ml and the median PSA doubling time was 3.4 months. At the diagnosis of metastasis, bone, lymph node and viscera were involved in 63%, 36%, and 6% of patients, respectively. Bone only metastases were found at initial metastatic diagnosis in 56 of 95 men (59%). Node-only metastases were identified in 30 patients (32%). The 3- and 5-year of cancer-specific survival from diagnosis of noncastrate metastases were 84% and 68%, respectively. In multivariate analysis, disease extent and PSA doubling time were significantly associated with survival outcome.

The 3- and 5-year actuarial disease-specific survival probabilities were 89% and 78% for a PSA doubling time of >3months and 71% and 42% for a PSA doubling time of <3 months, respectively. Only 26% of patients with extensive disease and a PSA doubling time of <3 months were alive 5 years after being diagnosed with noncastrate metastases, compared to 83% alive at 5 years who had minimal metastatic disease and a PSA doubling time of >3 months.

These data suggest that the risk of dying form prostate cancer is best determined from the initial pattern of metastatic spread and PSA kinetic, rather than time elapsing from prior disease states.

YossepowitchВ O, BiancoВ Jr.В FJ, EggenerВ SE, EasthamВ JA, ScherВ HI, ScardinoВ PT, GraefenВ M, LujГЎnВ M
Eur Urol 2006;epub
doi:10.1016/j.eururo.2006.10.045

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

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