Time to Prostate Specific Antigen Recurrence After Radical Prostatectomy and Risk of Prostate Cancer Specific Mortality

2006 ◽  
Vol 176 (4) ◽  
pp. 1404-1408 ◽  
Author(s):  
Stephen J. Freedland ◽  
Elizabeth B. Humphreys ◽  
Leslie A. Mangold ◽  
Mario Eisenberger ◽  
Alan W. Partin
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Specific Mortality ◽  
Cancer Specific Mortality

scholarly journals Prostate Cancer–Specific Mortality After Radical Prostatectomy for Patients Treated in the Prostate-Specific Antigen Era

2009 ◽  
Vol 27 (26) ◽  
pp. 4300-4305 ◽  
Author(s):  
Andrew J. Stephenson ◽  
Michael W. Kattan ◽  
James A. Eastham ◽  
Fernando J. Bianco ◽  
Ofer Yossepowitch ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Features ◽  
Specific Antigen ◽  
Clinical Trial Design ◽  
Gleason Grade ◽  
Patient Counseling ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose The long-term risk of prostate cancer–specific mortality (PCSM) after radical prostatectomy is poorly defined for patients treated in the era of widespread prostate-specific antigen (PSA) screening. Models that predict the risk of PCSM are needed for patient counseling and clinical trial design. Methods A multi-institutional cohort of 12,677 patients treated with radical prostatectomy between 1987 and 2005 was analyzed for the risk of PCSM. Patient clinical information and treatment outcome was modeled using Fine and Gray competing risk regression analysis to predict PCSM. Results Fifteen-year PCSM and all-cause mortality were 12% and 38%, respectively. The estimated PCSM ranged from 5% to 38% for patients in the lowest and highest quartiles of predicted risk of PSA-defined recurrence, based on a popular nomogram. Biopsy Gleason grade, PSA, and year of surgery were associated with PCSM. A nomogram predicting the 15-year risk of PCSM was developed, and the externally validated concordance index was 0.82. Neither preoperative PSA velocity nor body mass index improved the model's accuracy. Only 4% of contemporary patients had a predicted 15-year PCSM of greater than 5%. Conclusion Few patients will die from prostate cancer within 15 years of radical prostatectomy, despite the presence of adverse clinical features. This favorable prognosis may be related to the effectiveness of radical prostatectomy (with or without secondary therapy) or the low lethality of screen-detected cancers. Given the limited ability to identify contemporary patients at substantially elevated risk of PCSM on the basis of clinical features alone, the need for novel markers specifically associated with the biology of lethal prostate cancer is evident.

scholarly journals Time to Prostate-Specific Antigen Nadir After Radical Prostatectomy – a new potential predictive prognostic parameter and its impact on clinical outcomes

2020 ◽  
Author(s):  
Minh Dac Tran ◽  
Kim L Moretti ◽  
Michael E O'Callaghan
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Outcomes ◽  
Competing Risks ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Abstract BackgroundTo investigate and validate previously published associations between time to prostate-specific antigen nadir and the time-to-nadir after radical prostatectomy with biochemical recurrence and to extend this analysis to overall survival and prostate cancer-specific mortality risk. MethodsThis is a retrospective analysis of 1796 men from the South Australian Prostate Cancer Clinical Outcomes Collaborative database treated with radical prostatectomy between 1998-2018 with available prostate-specific antigen nadir data within 1-6 months after surgery. Uni- and multivariable analyses of prostate-specific antigen nadir, time-to-nadir, biochemical recurrence and death were performed with Cox and competing risks models (adjusted for age, surgery year, tumour features and preoperative prostate-specific antigen).ResultsThe univariable analysis demonstrated those with shorter time-to-nadir <3 months had a decreased risk of biochemical recurrence (log-rank, p=0.0098) compared to those with longer time-to-nadir 3-6 months. For men with a time-to-nadir <3 months, a Log-rank test showed a decreased risk of prostate cancer-specific mortality (p=0.026) compared to time-to-nadir 3-6 months, without a difference in overall survival. Multivariable competing risk analyses indicated that biochemical recurrence was more likely when time-to-nadir was 3-6 months compared to <3 months (sHR=1.43, CI 1.01-2.02, p=0.04).ConclusionsAmong men undergoing radical prostatectomy, a shorter post-operative time-to-nadir <3 months is associated with decreased risk of biochemical recurrence compared to time-to-nadir 3-6 months. Following adjustment for confounders and competing risks, there was no significant difference in time-to-nadir for mortality outcomes.

PROSTATE CANCER-SPECIFIC MORTALITY AFTER RADICAL PROSTATECTOMY FOR PATIENTS TREATED IN THE PROSTATE- SPECIFIC ANTIGEN ERA

2008 ◽  
Vol 179 (4S) ◽  
pp. 649-649 ◽  
Author(s):  
Andrew J Stephenson ◽  
Michael W Kattan ◽  
James A Eastham ◽  
Eric A Klein ◽  
Fernando J Bianco ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Cancer-Specific Mortality After Surgery or Radiation for Patients With Clinically Localized Prostate Cancer Managed During the Prostate-Specific Antigen Era

2003 ◽  
Vol 21 (11) ◽  
pp. 2163-2172 ◽  
Author(s):  
Anthony V. D’Amico ◽  
Judd Moul ◽  
Peter R. Carroll ◽  
Leon Sun ◽  
Deborah Lubeck ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Risk Groups ◽  
The United States ◽  
Localized Prostate Cancer ◽  
Institutional Setting ◽  
Psa Failure ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose: To determine whether pretreatment risk groups shown to predict time to prostate cancer–specific mortality (PCSM) after treatment at a single institution retained that ability in a multi-institutional setting. Patients and Methods: From 1988 to 2002, 7,316 patients treated in the United States at 44 institutions with either surgery (n = 4,946) or radiation (n = 2,370) for clinical stage T1c-2, N0 or NX, M0 prostate cancer made up the study cohort. A Cox regression analysis was performed to determine the ability of pretreatment risk groups to predict time to PCSM after treatment. The relative risk (RR) of PCSM and 95% confidence intervals (CIs) were calculated for the intermediate- and high-risk groups relative to the low-risk group. Results: Estimates of non-PCSM 8 years after prostate-specific antigen (PSA) failure were 4% v 15% (surgery versus radiation; Plog rank = .002) compared with 13% v 18% (surgery versus radiation; Plog rank = .35) for patients whose age at the time of PSA failure was less than 70 as compared with ≥ 70 years, respectively. The RR of PCSM after treatment for surgery-managed patients with high- or intermediate-risk disease was 14.2 (95% CI, 5.0 to 23.4; PCox < .0001) and 4.9 (95% CI, 1.7 to 8.1; PCox = .0037), respectively. These values were 14.3 (95% CI, 5.2 to 24.0; PCox < .0001) and 5.6 (95% CI, 2.0 to 9.3; PCox = .0012) for radiation-managed patients. Conclusion: This study provided evidence to support the prediction of time to PCSM after surgery or radiation on the basis of pretreatment risk groups for patients with clinically localized prostate cancer managed during the PSA era.

Prostate-specific antigen-based serial screening may decrease prostate cancer-specific mortality

Urology ◽  
2006 ◽  
Vol 68 (2) ◽  
pp. 342-347 ◽  
Author(s):  
Jason A. Efstathiou ◽  
Ming-Hui Chen ◽  
William J. Catalona ◽  
David G. McLeod ◽  
Peter R. Carroll ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Specific Mortality ◽  
Cancer Specific Mortality
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