Elton Llukani1, Herbert Lepor1. 1. Department of Urology, New York University Langone Medical Center, New York, NY, USA.
Abstract
OBJECTIVES: To examine the characteristics and management of earlier (within 5 years) vs later (after 5 years) biochemical recurrence (BCR) after radical prostatectomy (RP). MATERIALS AND METHODS: Between October 2000 and October 2009, 1597 men underwent open retropubic RP. BCRs were managed using salvage radiation therapy (SRT), androgen deprivation therapy (ADT) or active surveillance (AS). BCR-free survival was assessed using Kaplan-Meier analysis. Factors predicting earlier or later BCR and BCR after SRT were assessed using logistic regression and Cox proportional hazard models, respectively. RESULTS: The probabilities of developing BCR within 5 years and 10 years were 12.3% (95% confidence interval [CI] 10.7-13.9) and 18.4% (95% CI 16.2-20.6), respectively. On multivariate analysis, prostate-specific antigen doubling time, positive surgical margins and pathological Gleason score significantly differentiated earlier from later BCR. Overall, 74.5, 12.7 and 12.7% of men developing BCR underwent SRT, ADT or AS, respectively. A significantly greater proportion of men in the earlier BCR group underwent SRT (80.8 vs 59%) and ADT (14.6 vs 8.2%), and a significantly greater proportion of men in the later BCR group underwent AS (32.8 vs 4.6%; P<0.001). The response to SRT was independent of time to BCR. On multivariate analysis, clinical stage and pathological stage significantly predicted failure of SRT. CONCLUSIONS: Approximately one third of BCRs occurred between 5 and 10 years after RP. The aetiology and management of BCR was dependent on time to BCR, whereas response to SRT was independent of time to recurrence. Long-term follow-up is mandatory beyond 5 years for all men after RP.
OBJECTIVES: To examine the characteristics and management of earlier (within 5 years) vs later (after 5 years) biochemical recurrence (BCR) after radical prostatectomy (RP). MATERIALS AND METHODS: Between October 2000 and October 2009, 1597 men underwent open retropubic RP. BCRs were managed using salvage radiation therapy (SRT), androgen deprivation therapy (ADT) or active surveillance (AS). BCR-free survival was assessed using Kaplan-Meier analysis. Factors predicting earlier or later BCR and BCR after SRT were assessed using logistic regression and Cox proportional hazard models, respectively. RESULTS: The probabilities of developing BCR within 5 years and 10 years were 12.3% (95% confidence interval [CI] 10.7-13.9) and 18.4% (95% CI 16.2-20.6), respectively. On multivariate analysis, prostate-specific antigen doubling time, positive surgical margins and pathological Gleason score significantly differentiated earlier from later BCR. Overall, 74.5, 12.7 and 12.7% of men developing BCR underwent SRT, ADT or AS, respectively. A significantly greater proportion of men in the earlier BCR group underwent SRT (80.8 vs 59%) and ADT (14.6 vs 8.2%), and a significantly greater proportion of men in the later BCR group underwent AS (32.8 vs 4.6%; P<0.001). The response to SRT was independent of time to BCR. On multivariate analysis, clinical stage and pathological stage significantly predicted failure of SRT. CONCLUSIONS: Approximately one third of BCRs occurred between 5 and 10 years after RP. The aetiology and management of BCR was dependent on time to BCR, whereas response to SRT was independent of time to recurrence. Long-term follow-up is mandatory beyond 5 years for all men after RP.