Prostate news article, October 2005
| ASSESSING THE
IMPLICATIONS OF A PSA RISE AFTER RADICAL PROSTATECTOMY
Freedland SJ, Humphreys EB, Mangold LA et al. JAMA.2005; 294: 433-439. Reviewed by: Dr Charlotte Foley MA BMBCh MRCS |
Though radical prostatectomy is always performed with curative intent approximately 35% of men will develop a PSA rise indicative of cancer recurrence within 10 years of their operation. The reaction to this feared and worrying event is often to embark on further adjuvant treatment. Now Dr Alan Partin has looked at the survival prospects of such men. He feels that the exquisite sensitivity of the PSA test means that recurrent disease is detected years in advance of symptoms. In fact one study of his patients with PSA relapse showed that a median of 8 years passed before they developed metastases, and a median of 5 further years passed before they died of it.
It would be useful to be able to tell which men with a PSA rise after radical prostatectomy can be spared intervention and which need aggressive additional treatment. Looking at 369 patients with an impressive follow up of 10 years, Dr Partin has identified three risk factors that influence the likelihood of such men dying of prostate cancer. Patients are at high or low risk respectively if their cancer was Gleason grade 8-10 or 7 or less; if their PSA rose within or later than 3 years after surgery; or particularly, whether the timespan over which their PSA level doubled was in the magnitude of 3 months or over 15. Based on his data, he presents a table giving the chance of surviving prostate cancer for each combination of these variables. A patient’s so called ‘PSA doubling time’ may be a useful way of judging the effectiveness of an intervention in future research as it would be measurable far sooner than their survival.
These tables, though constructed from a small patient population, will help doctors and patients assess the significance of any PSA rise after surgery.
Freedland SJ, Humphreys EB, Mangold LA et al.
Risk of prostate cancer-specific mortality following biochemical
recurrence after radical prostatectomy.
JAMA.2005; 294: 433-439.