Longer metastasis-free survival predicts better overall survival in men who experience biochemical recurrence of prostate cancer (PCa) after radical prostatectomy, according to a new study.

Michael T. Schweizer, MD, and colleagues at Johns Hopkins University in Baltimore, and colleagues retrospectively studied 450 men with biochemically recurrent PCa, defined as a PSA level of 0.2 ng/mL or higher after radical prostatectomy. Metastatic disease developed in 140 of them. Androgen deprivation therapy (ADT) was deferred until after development of metastases. The cohort had a median metastasis-free survival (MFS) of 10.2 years and the median overall survival (OS) after metastasis of 6.6 years. After adjusting for other known prognostic variables, increasing MFS was associated with a decreasing risk of death, the researchers reported online ahead of print in the Annals of Oncology.

In addition, the number of metastases, the presence or absence of pain with metastases, and use or non-use of bisphosphonates predicted OS. Patients who had three or fewer metastases had a 50% decreased risk of death compared with those who had four or more metastases. Patients who did not have pain with their metastases had a 57% decreased risk of death compared with those who did. Patients who used bisphosphonates had a 40% decreased risk of death compared with those who did not.

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The study findings suggest that MFS may be a reasonable proximal endpoint when evaluating novel medications patients who experience PSA recurrence after local therapy, according to the investigators.