Delayed PSA Recurrence a Good Sign

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Longer time to relapse is associated with a decreased risk of dying from prostate cancer.

PSA recurrence (PSAR) more than five years after radical prostatectomy for prostate cancer is associated with better cancer-specific survival than PSAR less than five years after surgery, a study found.

A team at the Duke Prostate Center, which is part of Duke University Medical Center in Durham, N.C., studied 1,207 prostate cancer patients who had PSAR following radical prostatectomy. The researchers, led by Judd W. Moul, MD, divided the men into two groups: those with early PSAR (recurrence within five years) and those with delayed PSAR (recurrence after five years).

Approximately 90% of the subjects had early PSAR. Metastasis developed in 173 (14.3%) patients, and 89 (7.4%) died from prostate cancer.

The median time to prostate cancer-related death in the delayed PSAR group was 10.7 years after radical prostatectomy compared with 7.6 years in the early PSAR group, Dr. Moul's group reported in Urology (2009; published online ahead of print).

“The survival benefit observed is likely a result of decreased aggressiveness of prostate cancer in the delayed PSAR group,” the authors wrote.

The two groups did not differ significantly with respect to metastasis-free survival.

Men with pathologic Gleason sums less than 7 were twice as likely to have delayed PSAR as patients with Gleason sums greater than 7. “This is clinically important, as patients with high-grade Gleason sums are at increased risk for early PSAR, indicating this group may benefit from more frequent follow-up or salvage therapies,” the researchers noted.

In addition, men with PSA levels below 10 ng/mL at the time of their cancer diagnosis were twice as likely to have delayed PSAR as those with PSA levels higher than 20 at diagnosis.

Despite the survival benefit observed in the study, “there is still a clinically relevant proportion of patients with delayed PSAR who go on to develop metastasis and ultimately die from prostate cancer,” the authors wrote. Consequently, patients with characteristics of the group with delayed PSAR need to continue regular follow-up appointments even after five years of disease-free survival, they stated.

The investigators observed that because of the time it takes for patients with delayed PSAR to progress to having metastatic disease, more data with longer follow-up times are needed.
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