SAN FRANCISCO—Nearly one in five men who undergo radical prostatectomy (RP) for high-risk prostate cancer experience biochemical recurrence (BCR) within two years of surgery, according to the findings of a European study.
These men are at significantly elevated risk of prostate cancer-related death and therefore should be considered for trials assessing aggressive systemic treatment strategies, said investigator Martin Spahn, MD, of University Hospital Würzburg in Würzburg, Germany, who reported study findings at the American Urological Association annual meeting.
Dr. Spahn and his collaborators studied 1,584 men with high-risk prostate cancer (PSA level greater than 20 ng/mL, clinical stage cT3-4, or biopsy Gleason score 8-10) prior to RP and pelvic lymph node dissection. The subjects underwent surgery at seven tertiary referral centers between 1987 and 2009. The investigators defined BCR as a PSA level of 0.2 ng/mL on two subsequent measurements. The patients had a mean age of 65.4 years at the time of surgery (range 41-89 years) and a mean preoperative PSA level of 33.5 ng/mL.
After a mean follow-up period of 67 months, BCR occurred in 278 men (17.5%) within two years of surgery and in 239 men (15%) more than two years post-operatively. The 10-year cancer-specific survival (CSS) was 73.2% for the men who experienced BCR within two years of surgery compared with 85.3% for the men who had BCR more than two years post-operatively. In addition, an analysis of a subgroup of 406 patients who did not receive adjuvant or neoadjuvant treatment revealed a more pronounced difference in CSS between the groups (77.2% vs. 100%).
Compared with patients who did not experience BCR during follow-up, those who had BCR within two years of surgery had significantly worse 10-year overall survival (OS): 58.3% vs. 81.4%. The OS of patients who had BCR more than two years post-operatively was not significantly different (75.9%).