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Long‐term cancer control outcomes in patients with biochemical recurrence and the impact of time from radical prostatectomy to biochemical recurrence
Author(s) -
Pompe Raisa S.,
Gild Philipp,
Karakiewicz Pierre I.,
Bock LeaPhiline,
Schlomm Thorsten,
Steuber Thomas,
Graefen Markus,
Huland Hartwig,
Tian Zhe,
Tilki Derya
Publication year - 2018
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.23511
Subject(s) - biochemical recurrence , medicine , prostate cancer , prostatectomy , urology , proportional hazards model , breakpoint cluster region , oncology , adjuvant , cancer , surgery , gynecology , receptor
Background Rates of metastatic progression (MP) and prostate cancer mortality (PCSM) are variable after biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP). To describe long‐term oncological outcomes of BCR patients and to analyze risk factors for further outcomes in these men with a special focus on RP‐BCR time. Methods We retrospectively analyzed the data of 5509 RP patients treated between 1992 and 2006. Of those, we included 1321 patients who experienced BCR (PSA level ≥0.2 ng/mL) and did not receive any neoadjuvant or adjuvant therapy. Kaplan‐Meier and time dependent Cox regression models were used. Results Median follow‐up was 121 months. MP was recorded in 177 (13.4%), PCSM in 126 (9.5%), and overall mortality (OM) in 264 (20.0%) patients. Patients with MP had worse tumor characteristics such as higher Gleason Scores (GS), rapid PSA doubling‐time (DT), and shorter RP‐BCR time intervals. MP‐free, PCSM‐free, and overall survival rates were significantly worse in patients with RP‐BCR time of <12 months versus patients with 12‐35.9 or ≥36 months ( P ≤ 0.001). Besides higher GS and rapid PSA‐DT, RP‐BCR time independently predicted MP, PCSM, and OM in multivariable regression analyses. Relative to the intermediate and longest RP‐BCR time interval, the shortest interval (<12) carried the highest risk for all three endpoints. Conclusions Only a small proportion of BCR patients proceed to MP or PCSM. Besides higher GS and rapid PSA‐DT a shorter RP‐BCR interval (<12 months) heralds the most aggressive phenotype for progression to all three examined endpoints: MP, PCSM, and OM.