Men with earlier versus later biochemical recurrence of prostate cancer after radical prostatectomy have different etiologies for rising PSA levels, researchers concluded.

Elton Llukani, MD, and Herbert Lepor, MD, of New York University Langone Medical Center, studied 1597 men who underwent open retropubic radical prostatectomy (RP) from October 2000 to October 2009. The probabilities of developing biochemical recurrence (BCR) within 5 and 10 years were 12.3% and 18.4%, respectively, the investigators reported online ahead of print in BJU International.

The investigators defined BCR as 2 or more consecutive PSA measurements of 0.2 ng/mL or higher following RP. They defined earlier and later BCR as BCR occurring before and after 5 years.

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Compared with patients who had earlier BCR, those who experienced later BCR had significantly lower biopsy Gleason scores, pathologic stage, pathologic Gleason score, positive surgical margin (PSM) rates, and preoperative PSA level, as well as significantly longer PSA doubling time (PSADT) and a greater likelihood of achieving an undetectable PSA nadir.

On multivariate analysis, men with later BCR had lower pathologic Gleason scores, lower PSM rates, and longer PSADT, suggesting that, overall, earlier BCR represents more aggressive disease, Drs Llukani and Lepor stated.

Overall, 74.5%, 12.7%, and 12.7% of patients experiencing BCR underwent salvage radiation therapy (SRT), androgen-deprivation therapy (ADT), and active surveillance (AS), respectively. A significantly greater proportion of men in the earlier BCR group underwent SRT (80.8% vs 59%) and ADT (14.6% vs 8.2%), and a significantly greater proportion of men in the later BCR group underwent AS (32.8% vs 4.6%), according to the investigators.

Men undergoing AS had a longer time to BCR and a longer PSA doubling time (PSADT) than those undergoing SRT. Compared with patients undergoing ADT, those undergoing SRT were younger, had a longer time to BCR and a longer PSA doubling time, and had lower biopsy and pathologic Gleason scores. They also had a greater likelihood of achieving a PSA nadir of 0.05 ng/mL or less.

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Llukani E, Lepor H. Aetiology and management of earlier vs later biochemical recurrence after retropubic radical prostatectomy. BJU Int 2017; published online ahead of print.