PSA doubling time less than three months in men with PSA progression after RP raised risk 20-fold.

PSA doubling time (PSADT), Gleason score, and time to PSA progression are strong independent predictors of metastasis-free survival in prostate cancer patients who experience PSA recurrence following radical prostatectomy (RP).

Emmanuel S. Antonarakis, MD, and colleagues at Johns Hopkins University in Baltimore analyzed data on 774 men treated with RP between April 1982 and July 2008. All patients had PSA recurrence and never received adjuvant or salvage therapy.

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The mean follow-up after surgery was 8.5 years, with some men followed for as long as 25 years. The mean time from RP to PSA recurrence was 4.2 years. In those with metastases, the mean time from PSA recurrence to metastasis was 3.1 years. The mean PSA at the time of metastasis was 120 ng/mL. In survival analyses, the median time from PSA recurrence to metastasis was 10 years.

Metastasis-free survival (from PSA recurrence) for men with a PSADT less than 3, 3-8.9, and 9-14.9 months was one, four, and nine years, respectively. For men with a PSADT of 15 months or more, metastasis-free survival was 15 years.

Compared with a PSADT of 15 months or more, a PSADT of less than three months was associated with a significant 20.6 times greater risk of metastasis; a PSADT of 3-8.9 months was associated with a significant 6.3 times greater risk.

A Gleason score of 8 or higher was associated with a twofold greater risk of metastasis compared with a lower Gleason score. In addition, compared with men whose time to PSA progression was three years or less, those with a longer time to PSA progression had a 70% decreased risk of metastasis.