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Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy.
Cancer. 2004 Dec 01; 101(11):2549-56.C

Abstract

BACKGROUND

To the authors' knowledge, the natural history of disease progression to distant metastasis is unknown in men who fail to achieve an undetectable prostate-specific antigen (PSA) level after radical retropubic prostatectomy (RRP),. The authors assessed the clinical outcome of men with a persistently detectable PSA level after RRP for clinically localized prostate carcinoma.

METHODS

Between 1989 and 2002, 160 men failed to achieve an undetectable PSA level (>/= 0.1 ng/mL) after undergoing RRP for clinically localized prostate carcinoma. No patient received adjuvant therapy before documented metastasis. The Kaplan-Meier method was used to estimate distant metastasis-free survival. Univariate and multivariate Cox proportional hazards regression was used to assess the ability of clinical and pathologic variables to predict distant metastasis-free survival.

RESULTS

The probability of distant metastasis-free survival at 3 years, 5 years, and 10 years was reported to be 68%, 49%, and 22%, respectively. Seventy-five men (47%) developed distant metastases after RRP (median time to metastases of 5.0 years; range, 0.5-13 years). The combination of RRP Gleason score, seminal vesicle status, and lymph node status resulted in 3 risk groups for the prediction of distant metastasis-free survival (hazards ratio [HR] = 1.6; P < 0.01). The slope of PSA changes approximately 3-12 months after RRP at a cutoff value >/= 0.05 was found to be even more predictive of distant metastasis-free survival (HR = 2.9; P < 0.01).

CONCLUSIONS

Many patients remained free of metastatic disease for an extended period despite failing to achieve an undetectable PSA level after undergoing RRP for clinically localized prostate carcinoma. However, other patients experienced rapid disease progression to distant metastasis. The authors defined clinical (PSA slope) and pathologic (Gleason score) prognostic variables to help identify those patients with a higher risk of developing distant metastasis after undergoing RRP.

Authors+Show Affiliations

The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. crogers6@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15470681

Citation

Rogers, Craig G., et al. "Natural History of Disease Progression in Patients Who Fail to Achieve an Undetectable Prostate-specific Antigen Level After Undergoing Radical Prostatectomy." Cancer, vol. 101, no. 11, 2004, pp. 2549-56.
Rogers CG, Khan MA, Craig Miller M, et al. Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy. Cancer. 2004;101(11):2549-56.
Rogers, C. G., Khan, M. A., Craig Miller, M., Veltri, R. W., & Partin, A. W. (2004). Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy. Cancer, 101(11), 2549-56.
Rogers CG, et al. Natural History of Disease Progression in Patients Who Fail to Achieve an Undetectable Prostate-specific Antigen Level After Undergoing Radical Prostatectomy. Cancer. 2004 Dec 1;101(11):2549-56. PubMed PMID: 15470681.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy. AU - Rogers,Craig G, AU - Khan,Masood A, AU - Craig Miller,M, AU - Veltri,Robert W, AU - Partin,Alan W, PY - 2004/10/8/pubmed PY - 2004/12/28/medline PY - 2004/10/8/entrez SP - 2549 EP - 56 JF - Cancer JO - Cancer VL - 101 IS - 11 N2 - BACKGROUND: To the authors' knowledge, the natural history of disease progression to distant metastasis is unknown in men who fail to achieve an undetectable prostate-specific antigen (PSA) level after radical retropubic prostatectomy (RRP),. The authors assessed the clinical outcome of men with a persistently detectable PSA level after RRP for clinically localized prostate carcinoma. METHODS: Between 1989 and 2002, 160 men failed to achieve an undetectable PSA level (>/= 0.1 ng/mL) after undergoing RRP for clinically localized prostate carcinoma. No patient received adjuvant therapy before documented metastasis. The Kaplan-Meier method was used to estimate distant metastasis-free survival. Univariate and multivariate Cox proportional hazards regression was used to assess the ability of clinical and pathologic variables to predict distant metastasis-free survival. RESULTS: The probability of distant metastasis-free survival at 3 years, 5 years, and 10 years was reported to be 68%, 49%, and 22%, respectively. Seventy-five men (47%) developed distant metastases after RRP (median time to metastases of 5.0 years; range, 0.5-13 years). The combination of RRP Gleason score, seminal vesicle status, and lymph node status resulted in 3 risk groups for the prediction of distant metastasis-free survival (hazards ratio [HR] = 1.6; P < 0.01). The slope of PSA changes approximately 3-12 months after RRP at a cutoff value >/= 0.05 was found to be even more predictive of distant metastasis-free survival (HR = 2.9; P < 0.01). CONCLUSIONS: Many patients remained free of metastatic disease for an extended period despite failing to achieve an undetectable PSA level after undergoing RRP for clinically localized prostate carcinoma. However, other patients experienced rapid disease progression to distant metastasis. The authors defined clinical (PSA slope) and pathologic (Gleason score) prognostic variables to help identify those patients with a higher risk of developing distant metastasis after undergoing RRP. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/15470681/Natural_history_of_disease_progression_in_patients_who_fail_to_achieve_an_undetectable_prostate_specific_antigen_level_after_undergoing_radical_prostatectomy_ L2 - https://doi.org/10.1002/cncr.20637 DB - PRIME DP - Unbound Medicine ER -