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Aetiology and management of earlier vs later biochemical recurrence after retropubic radical prostatectomy
Author(s) -
Llukani Elton,
Lepor Herbert
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13816
Subject(s) - biochemical recurrence , breakpoint cluster region , medicine , prostatectomy , hazard ratio , radical retropubic prostatectomy , proportional hazards model , confidence interval , urology , logistic regression , pathological , stage (stratigraphy) , prostate cancer , surgery , cancer , biology , paleontology , receptor
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 . BCR s 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 BCR s 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 .