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Sub-category:
Epidemiology, Risk factors, Prevention, and Health Services Research
Category:
Genitourinary Cancers
Meeting:
2009 Genitourinary Cancers Symposium
Abstract No:
5
Author(s):
E. S. Antonarakis, B. J. Trock, E. B. Humphreys, M. A. Carducci, P. C. Walsh, A. W. Partin, M. A. Eisenberger; Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
Abstract:
Background: In men with prostate specific antigen (PSA) recurrence following radical prostatectomy (RP) and no other therapy, the natural history of metastatic progression has previously been described in 1999. We now report data reflecting up to 25 years of follow-up. Methods: We performed a retrospective analysis of 774 men treated with RP between 4/1982 and 7/2008 who developed PSA recurrence (≥0.2 ng/ml) and never received adjuvant or salvage therapy. We investigated factors influencing the development of metastases. Results: Mean follow-up after RP was 8.5 y (median 8 y; range 1-25 y). Of 774 men with PSA recurrence, 295 (38%) developed metastases, and 433 had data on PSA doubling time (PSADT), forming our cohort. The mean time from RP to PSA recurrence was 4.2 y (median 3 y; range 1-19 y). In those with metastases, the mean time from PSA recurrence to metastasis was 3.1 y (median 2 y; range 0-15 y). The mean PSA at the time of metastasis was 120 ng/ml (median 35.4 ng/ml; range 0.5-2,026 ng/ml). In Cox regression analysis, time to PSA progression (P<0.0001), Gleason score (P=0.0002), and PSADT (P<0.0001) were predictive of the development of metastases (Table). The median time from RP to metastasis was 18 y (95% CI 16-20 y). Metastasis-free survival for men with PSADT <3 mo, 3-8.9 mo, 9-14.9 mo, and ≥15 mo was 3 y (95% CI 2-4 y), 7 y (95% CI 5-8 y), 16 y (95% CI 13-20 y), and >21 y (95% CI not calculable), respectively. Conclusions: PSADT, Gleason score, and time to PSA progression are strong independent predictors of metastasis-free survival in men with PSA-recurrent PCa. Additional data regarding the relationship of PSA dynamics and metastasis will be presented. These data facilitate patient counseling and logical risk-based treatment planning. They also provide the background for appropriate selection of patients, treatments, and endpoints for clinical trials.
| Multivariable Cox Proportional Hazards Regression Analysis | | Variable | Hazard Ratio (95% CI) | P-value | PSADT
<3 mo
3-8.9 mo
9-14.9 mo
≥15 mo | -
20.6 (11.2-38.1)
6.3 (3.8-10.7)
2.4 (1.3-4.4)
1 [Reference] | <0.0001
<0.0001
0.004 | Gleason score
≥8
<8 | -
2.0 (1.4-3.0)
1 [Reference] | 0.0002 | Time to PSA progression
>3 y
≤3 y | -
0.3 (0.2-0.4)
1 [Reference] | <0.0001 |
Faculty Disclosures
Abstract Disclosures
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy
and are designated with a caret symbol (^) here and in the print version.
 Associated Presentation(s):
Other Abstracts in this Sub-Category:
Abstracts by E. S. Antonarakis:
Presentations by E. S. Antonarakis:
Educational Book Manuscripts by E. S. Antonarakis:
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