Long‐term overall survival and metastasis‐free survival for men with prostate‐specific antigen‐recurrent prostate cancer after prostatectomy: analysis of the Center for Prostate Disease Research National Database
Authors: Antonarakis Emmanuel S. , Chen Yongmei , Elsamanoudi Sally I. , Brassell Stephen A. , Da Rocha Mario V. , Eisenberger Mario A. , McLeod David G. 
Published: November 2010

Study Type – Prognosis (retrospective cohort)

Level of Evidence 2b

What’s known on the subject? and What does the study add?

Patients who develop biochemical (PSA) recurrence after prostatectomy may subsequently develop metastases leading to their eventual death. However, many such patients receive additional therapies before developing metastases, so the natural history of disease progression in these patients is poorly described. We aimed to report metastasis‐free survival and overall survival for such patients using a multicentre database.

We present data on the natural history of metastatic progression and survival for men treated with radical prostatectomy who did not receive additional adjuvant or salvage therapies before developing metastases. Even in the absence of subsequent therapies, we demonstrate that metastasis‐free survival and overall survival may be prolonged but are variable. We confirm that PSA doubling time is the strongest prognostic factor determining risk of metastasis and death in men with biochemically‐recurrent prostate cancer.

OBJECTIVE

To describe metastasis‐free survival (MFS) and overall survival (OS) among men with prostate‐specific antigen (PSA)‐recurrent prostate cancer after radical prostatectomy who did not receive additional therapy until metastasis, using a multicentre database capturing a wide ethnic mix.

PATIENTS AND METHODS

A retrospective analysis of the Center for Prostate Disease Research National Database (comprised of five US military hospitals and one civilian centre) was performed for patients with PSA relapse (≥0.2 ng/mL) after radical prostatectomy who had no additional therapy until the time of radiographic metastatic disease.

We investigated factors influencing metastasis and all‐cause mortality using univariate and multivariate Cox regression analysis.

RESULTS

There were a total of 346 men who underwent radical prostatectomy between May 1983 and November 2008 and fulfilled the entry criteria. All patients had information on survival and 190 men had information on metastasis. Among patients with survival data (n= 346), 10‐year OS was 79% after a median follow‐up of 8.6 years from biochemical recurrence.

Among men with metastasis data (n= 190), 10‐year MFS was 46% after a median follow‐up of 7.5 years.

In Cox regressions, four clinical factors (Gleason score, pathological stage, time to PSA relapse and PSA doubling time), as well as age, were predictive of OS and/or MFS in univariate analysis, although only PSA doubling time (≥9 vs 3–8.9 vs <3 months) remained independently predictive of these outcomes in multivariate analysis (P < 0.001).

CONCLUSIONS

This multicentre multi‐ethnic dataset shows that OS and MFS can be extensive for men with PSA‐recurrent prostate cancer, even in the absence of further therapy before metastasis.

This unique patient cohort, the second largest of its type after the Johns Hopkins cohort, confirms that PSA doubling time is the strongest determinant of OS and MFS in men with PSA‐recurrent disease.

Longer follow‐up and more events will be required to determine whether other variables may also contribute to these outcomes.