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Stratification of patient risk based on prostate-specific antigen doubling time after radical retropubic prostatectomy.
Mayo Clin Proc. 2007 Apr; 82(4):422-7.MC

Abstract

OBJECTIVE

To assess the risk of local recurrence, systemic progression, and death from cancer among patients who experience biochemical relapse after radical retropubic prostatectomy and to stratify those patients by prostate-specific antigen (PSA) doubling time (DT).

PATIENTS AND METHODS

We identified patients who experienced biochemical recurrence (defined as a PSA level < or =0.4 ng/mL) after radical prostatectomy from January 1, 1990, to December 31, 1999, for prostate adenocarcinoma. The PSA-DT was calculated by log linear regression using all PSA values within 2 years of biochemical recurrence. Local recurrence- and systemic progression- free survival and cancer-specific survival were estimated using the Kaplan-Meier method and analyzed by the log-rank test and Cox models.

RESULTS

Biochemical recurrence was noted in 1521 (27%) of 5533 men during the follow-up period. Of the 1064 patients with a calculable PSA-DT, 322 (30%) had a PSA-DT of less than 1 year, 357 (34%) had a PSA-DT of 1 to 9.9 years, and 385 (36%) had a PSA-DT of 10 years or more. Patients with a PSA-DT of 10 years or more were less likely to have a higher preoperative PSA level, Gleason score, advanced pathologic stage, and seminal vesicle invasion. Patients with a PSA-DT of 10 years or more were at low risk of local recurrence (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.06-0.14; compared with patients with a PSA-DT of <1 year), systemic progression (HR, 0.05; 95% CI, 0.02-0.13), or death from cancer (HR, 0.15; 95% CI, 0.05-0.43).

CONCLUSIONS

Prostate-specific antigen DT is an independent predictor of clinical disease recurrence and mortality after surgical biochemical failure. Risk stratification into high-, intermediate-, and low-risk categories based on the PSA-DT provides helpful clinical information and assists in the development of salvage therapy trials.

Authors+Show Affiliations

Department of Urology, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. blute.michael@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17418069

Citation

Tollefson, Matthew K., et al. "Stratification of Patient Risk Based On Prostate-specific Antigen Doubling Time After Radical Retropubic Prostatectomy." Mayo Clinic Proceedings, vol. 82, no. 4, 2007, pp. 422-7.
Tollefson MK, Slezak JM, Leibovich BC, et al. Stratification of patient risk based on prostate-specific antigen doubling time after radical retropubic prostatectomy. Mayo Clin Proc. 2007;82(4):422-7.
Tollefson, M. K., Slezak, J. M., Leibovich, B. C., Zincke, H., & Blute, M. L. (2007). Stratification of patient risk based on prostate-specific antigen doubling time after radical retropubic prostatectomy. Mayo Clinic Proceedings, 82(4), 422-7.
Tollefson MK, et al. Stratification of Patient Risk Based On Prostate-specific Antigen Doubling Time After Radical Retropubic Prostatectomy. Mayo Clin Proc. 2007;82(4):422-7. PubMed PMID: 17418069.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stratification of patient risk based on prostate-specific antigen doubling time after radical retropubic prostatectomy. AU - Tollefson,Matthew K, AU - Slezak,Jeffrey M, AU - Leibovich,Bradley C, AU - Zincke,Horst, AU - Blute,Michael L, PY - 2007/4/10/pubmed PY - 2007/5/12/medline PY - 2007/4/10/entrez SP - 422 EP - 7 JF - Mayo Clinic proceedings JO - Mayo Clin. Proc. VL - 82 IS - 4 N2 - OBJECTIVE: To assess the risk of local recurrence, systemic progression, and death from cancer among patients who experience biochemical relapse after radical retropubic prostatectomy and to stratify those patients by prostate-specific antigen (PSA) doubling time (DT). PATIENTS AND METHODS: We identified patients who experienced biochemical recurrence (defined as a PSA level < or =0.4 ng/mL) after radical prostatectomy from January 1, 1990, to December 31, 1999, for prostate adenocarcinoma. The PSA-DT was calculated by log linear regression using all PSA values within 2 years of biochemical recurrence. Local recurrence- and systemic progression- free survival and cancer-specific survival were estimated using the Kaplan-Meier method and analyzed by the log-rank test and Cox models. RESULTS: Biochemical recurrence was noted in 1521 (27%) of 5533 men during the follow-up period. Of the 1064 patients with a calculable PSA-DT, 322 (30%) had a PSA-DT of less than 1 year, 357 (34%) had a PSA-DT of 1 to 9.9 years, and 385 (36%) had a PSA-DT of 10 years or more. Patients with a PSA-DT of 10 years or more were less likely to have a higher preoperative PSA level, Gleason score, advanced pathologic stage, and seminal vesicle invasion. Patients with a PSA-DT of 10 years or more were at low risk of local recurrence (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.06-0.14; compared with patients with a PSA-DT of <1 year), systemic progression (HR, 0.05; 95% CI, 0.02-0.13), or death from cancer (HR, 0.15; 95% CI, 0.05-0.43). CONCLUSIONS: Prostate-specific antigen DT is an independent predictor of clinical disease recurrence and mortality after surgical biochemical failure. Risk stratification into high-, intermediate-, and low-risk categories based on the PSA-DT provides helpful clinical information and assists in the development of salvage therapy trials. SN - 0025-6196 UR - https://www.unboundmedicine.com/medline/citation/17418069/Stratification_of_patient_risk_based_on_prostate_specific_antigen_doubling_time_after_radical_retropubic_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)61068-9 DB - PRIME DP - Unbound Medicine ER -