2060 DOES PSA DOUBLING TIME AFTER RADICAL PROSTATECTOMY CORRELATE WITH OVERALL SURVIVAL? A REPORT FROM THE SEARCH DATABASE GROUP

2010 ◽  
Vol 183 (4S) ◽  
Author(s):  
Anna Teeter ◽  
William Aronson ◽  
Joseph Presti ◽  
Martha Terris ◽  
Christopher Amling ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radical Prostatectomy ◽  
Doubling Time ◽  
Psa Doubling Time

Survival following early hormone therapy for men with rapid PSA doubling time within 2 years following radical prostatectomy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5065-5065
Author(s):  
B. Trock ◽  
M. Han ◽  
E. B. Humphreys ◽  
A. W. Partin ◽  
M. A. Eisenberger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radical Prostatectomy ◽  
Hormonal Therapy ◽  
Salvage Therapy ◽  
Biochemical Recurrence ◽  
Doubling Time ◽  
Early Recurrence ◽  
Psa Doubling Time ◽  
The Impact

5065 Background: Early hormonal therapy has been used in the salvage setting for men with biochemical recurrence following radical prostatectomy (RP), but no studies to date have been able to evaluate whether such treatment prolongs survival. We examined the impact of salvage hormonal therapy on overall survival (OS) in a cohort with long-term follow-up, and attempted to identify the subgroup most likely to benefit. Methods: Retrospective analysis of a cohort of 488 men undergoing RP at Johns Hopkins Hospital from 1982–2004, who experienced biochemical recurrence and received no salvage therapy (n = 386) or salvage hormonal therapy (n = 102); no one received adjuvant therapy. Survival was defined from biochemical recurrence to death from all causes, and analyzed with proportional hazards models with time-dependent covariates. Results: With median follow-up of 6 years after recurrence and 9 years after RP, there were 143 deaths (29%), including 105 from prostate cancer. After adjusting for PSA doubling time (PSADT), RP Gleason score, and year of surgery, hormonal therapy did not significantly improve OS for all men, compared to no salvage therapy: hazard ratio (HR) = 0.72 (95% confidence interval (CI): 0.45–1.17), p = 0.187. However, when restricted to men with early recurrence, i.e. within 2 years of RP, and with a rapid PSADT<6 months, hormonal therapy was associated with a large, significant improvement in OS: HR = 0.25 (95% CI: 0.08–0.71), p = 0.0095. This subgroup comprised 22% of the cohort. In contrast, there was no benefit of salvage hormonal therapy in men with early recurrence and PSADT>6 months: HR = 1.96 (95% CI: 0.89–4.31), p = 0.093, nor those who recurred more than 2 years after RP, regardless of PSADT. Conclusions: This study suggests that early salvage hormonal therapy may significantly and substantially prolong overall survival in the subgroup of men who experience an early biochemical recurrence with a rapid PSADT. These results are consistent with early recurrences being indicative of metastatic disease, while later recurrences are more likely to represent local recurrence. If validated, these results may provide useful stratification criteria for clinical trials. No significant financial relationships to disclose.

865: Comparison of Preoperative PSA Velocity or PSA Doubling Time as a Predictor of Outcome after Radical Prostatectomy

2006 ◽  
Vol 175 (4S) ◽  
pp. 279-279
Author(s):  
Stacy Loeb ◽  
Xiaoying Yu ◽  
Kimberly A. Roehl ◽  
Robert B. Nadler ◽  
Theresa Graif ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Doubling Time ◽  
Psa Doubling Time ◽  
Psa Velocity

950: Pre-Operative PSA Doubling Time is More Powerful than PSA or PSA Velocity as a Predictor of Post Radical Prostatectomy Outcomes

2005 ◽  
Vol 173 (4S) ◽  
pp. 257-257 ◽  
Author(s):  
Shomik Sengupta ◽  
Jeffrey M. Slezak ◽  
Eric J. Bergstralh ◽  
Bradley C. Leibovich ◽  
Robert P. Myers ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Doubling Time ◽  
Psa Doubling Time ◽  
Psa Velocity

Prediction of Response to Salvage Radiation Therapy in Patients With Prostate Cancer Recurrence After Radical Prostatectomy

2001 ◽  
Vol 19 (4) ◽  
pp. 1030-1039 ◽  
Author(s):  
Angelos K. Leventis ◽  
Shahrokh F. Shariat ◽  
Michael W. Kattan ◽  
E. Brian Butler ◽  
Thomas M. Wheeler ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Local Recurrence ◽  
Doubling Time ◽  
Salvage Radiation Therapy ◽  
Psa Relapse ◽  
Psa Doubling Time ◽  
Prostatic Fossa ◽  
Biopsy Confirmation

PURPOSE: To identify factors predictive of local recurrence as defined by a complete response to salvage radiation therapy in patients whose disease recurs after radical prostatectomy. PATIENTS AND METHODS: Ninety-five patients with recurrence after radical prostatectomy who were evaluated by prostatic fossa biopsies, and a subset of 49 of these patients treated with radiation for control of presumed or biopsy-proven local recurrence, were studied. RESULTS: Biopsies were positive in 40 (42%) of the 95 biopsied patients. Multivariate analysis revealed that prebiopsy prostate-specific antigen (PSA) level, postrecurrence PSA doubling time, and positive digital rectal examination (DRE) of the prostatic fossa were all statistically significant predictors of a positive biopsy. For the 49 patients subsequently treated with salvage radiation therapy, the overall actuarial 3- and 5-year PSA relapse-free probabilities were 43% and 24%, respectively. Univariate analysis showed no differences in the PSA relapse-free probabilities associated with any pathologic features of the radical prostatectomy specimen, biopsy confirmation of local recurrence, or DRE of the prostatic fossa. In multivariate analysis, controlling for all other variables, preradiation PSA and postrecurrence PSA doubling time measured before radiation were the only statistically significant predictors of outcome. CONCLUSION: DRE of the prostatic fossa, prebiopsy PSA, and postrecurrence PSA doubling time predict which patients will have biopsy-proven local recurrence. However, response to salvage radiation therapy is associated with postrecurrence PSA doubling time and with preradiation PSA level only. DRE of the prostatic fossa and biopsy confirmation of local recurrence are not associated with salvage radiation outcome.

Public health impact of PSA doubling time after radical prostatectomy on prostate cancer specific and overall survival

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4568-4568
Author(s):  
S. J. Freedland ◽  
E. B. Humphreys ◽  
L. A. Mangold ◽  
M. Eisenberger ◽  
D. J. George ◽  
...  
Keyword(s):  
Public Health ◽  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Doubling Time ◽  
Health Concern ◽  
Small Subset ◽  
Risk Of Death ◽  
Psa Doubling Time ◽  
Increased Risk ◽  
Psa Recurrence

4568 Background: Among patients treated with radical prostatectomy (RP) with a PSA recurrence, we previously found men with a PSA doubling time (PSADT) <3 months were at increased risk of prostate cancer death, though these men constituted a small subset of patients. We sought to determine the actual and predicted number of prostate cancer deaths stratified by PSADT. Methods: We retrospectively studied 379 men treated with RP between 1982 and 2000 with a PSA recurrence. We calculated the actual and 15-year actuarial number of prostate cancer deaths in each of the following PSADT categories: <3, 3.0–8.9, 9.0–14.9, and ≥15.0 months. Results: Median follow-up after PSA recurrence was 7 years. During this time, there were 76 prostate cancer deaths; the majority (51%) were among men with a PSADT of 3.0–8.9 months. Though men with a PSADT <3 months were at the greatest risk of death, this group accounted for only 20% (n=15) of all prostate cancer deaths. Using actuarial 15-year estimates of prostate cancer specific survival, 50% of all prostate cancer deaths were among men with a PSADT of 3.0–8.9 months while men with a PSADT <3 months accounted for only 13% of prostate cancer deaths. Using actuarial 15-year estimates of all-cause and prostate cancer specific mortality, among men with a PSADT <15 months, prostate cancer was estimated to be the cause of death in 94% (145/155). Only among men with a PSADT >15 months was the risk of competing causes of mortality high enough such that the majority of deaths were not attributed to prostate cancer. Conclusions: Among a select cohort of men treated with RP who experienced a PSA recurrence, prostate cancer was estimated to account for 75% of all deaths. Though men with a PSADT <3 months were at the greatest risk, the majority of deaths occurred among men with a PSADT of 3.0–8.9 months. Efforts to reduce prostate cancer mortality should focus on men with intermediate PSADT times (3.0–15.0 months) as they represent the greatest public health concern among men with PSA recurrence following RP. [Table: see text] No significant financial relationships to disclose.

PSA doubling time of ≤6 months as the optimal cutoff for predicting clinically relevant outcomes for men receiving salvage radiation therapy post radical prostatectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 167-167
Author(s):  
William C. Jackson ◽  
Skyler B. Johnson ◽  
Benjamin Foster ◽  
Corey Foster ◽  
Yeohan Song ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Predictive Value ◽  
Doubling Time ◽  
Univariate Analysis ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Data Set ◽  
Psa Doubling Time ◽  
The Impact

167 Background: Short PSA doubling time (PSADT) after biochemical recurrence (BR) post radical prostatectomy (RP) is known to predict worse outcomes following salvage external beam radiation therapy (SRT). The ideal PSADT cut-off, however, in this context remains uncertain. In this study, we sought to identify the best PSADT cut-off for predicting clinical outcomes following SRT for BR after RP. Methods: 575 patients who received SRT at a single institution for BR after RP were retrospectively reviewed in an IRB approved analysis. The impact of PSADT on biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall survival (OS) was assessed using Kaplan-Meier and Cox Proportional Hazards models. Results: Median follow up was 56.7 months post SRT. PSADTs could be calculated for 277 patients. PSADT strongly predicted BF, DM, PCSM, and OS on univariate analysis regardless of cut-off point. There was no statistical difference in BF, DM, PCSM, or OS between patients with PSADT <3 (n=40) and 3-6 months (n=61) or between 6-10 (n=62) and >10 months (n=114). A difference existed in BF (p<0.01 HR: 2.2 [95%CI: 1.4-3.5]) and DM (p=0.02 HR: 2.2 [95%CI: 1.2-4.3]) between PSADT of 3-6 and 6-10 months. PSADT ≤6 had the largest positive predictive value (PPV) for BF (70%), DM (36%), and PCSM (13%) at 5 years. There was no difference in negative predictive value between a PSADT >10 vs. >6 months for BF, DM, PCSM, and OS with 5 year rates of (60% vs. 60%, 86% vs. 86%, 99% vs. 98%, and 95 vs. 94% respectively). On multivariate analysis PSADT ≤6 was a strong predictor of BF (p<0.01 HR: 2.1 [95%CI: 1.5-3.0]), DM (p=0.01 HR: 2.0 [95%CI: 1.2-3.4]), and PCSM (p=0.04 HR: 2.3 [95%CI: 1.1-5.2]), with a trend towards predicting OS (p=0.12 HR: 1.5 [95%CI: 0.9-2.6]). Conclusions: A PSADT ≤6 months was the best predictor of outcomes in our data set, particularly for DM and PCSM. Currently, the most common predictive nomogram for SRT uses PSADT <10 months as the cut-off point for BF. These results suggest that using a PSADT of ≤6 months may improve the ability to predict clinically significant outcomes and hence identify men who may benefit from additional therapy.

PSA Doubling Time as a Predictor of Clinical Progression After Biochemical Failure Following Radical Prostatectomy for Prostate Cancer

2001 ◽  
Vol 76 (6) ◽  
pp. 576-581 ◽  
Author(s):  
Steven G. Roberts ◽  
Michael L. Blute ◽  
Erik J. Bergstralh ◽  
Jeffrey M. Slezak ◽  
Horst Zincke
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Doubling Time ◽  
Biochemical Failure ◽  
Clinical Progression ◽  
Psa Doubling Time
Sign in / Sign up

Export Citation Format

Share Document