RISK OF PROSTATE CANCER RECCURENCE 10 YEARS AFTER RADICALPROSTATECTOMY

NEW YORK (Reuters Health) Jun 29 - Men with undetectable prostate specific antigen (PSA) levels for at least a decade after radical prostatectomy have about a 1 in 16 chance of biochemical recurrence, according to a new study.
While recurrence rates vary depending on initial extent of disease, overall the results suggest a low risk after 10 years.
At that point, PSA testing can stop for men who had a prostatectomy with favorable Gleason 6 or better, "especially if they are older or ill," said the study's senior author, Dr. Patrick Walsh of Johns Hopkins University in Baltimore, in an email to Reuters Health. "For men with more aggressive disease, we recommend testing even if their PSA is undetectable at 10 years."
However, some urologists believe that even with a post-prostatectomy Gleason score of 7 or more, PSA surveillance can stop after 10 years if it's still negative.
"I do not recommend continued PSA testing beyond 10 years if the PSA level is undetectable, regardless of the Gleason score," said Dr. Andrew Stephenson of the Center of Urologic Oncology at Cleveland Clinic in Cleveland, OH, in an email. He was not involved in the current study.
Surveillance with PSA does not suffer the high false-positive rates and other limitations that plague PSA screening. "Screening for prostate cancer with PSA is fraught with controversy, however, PSA surveillance after surgery is one of the most sensitive markers we have in medicine," Dr. Matthew Tollefson, a urologist at Mayo Clinic in Rochester, MN, told Reuters Health in an email.
"The nice thing about PSA after surgery is that it is very accurate at detecting cancer recurrences," said Dr. Paul Nguyen, who directs prostate brachytherapy at Brigham and Women's Hospital in Boston. In email to Reuters Health, he said, "If the surgeon has removed the entire prostate, then the PSA should be less than 0.1, and anything above that very likely indicates cancer has returned."
In the current study, published online June 15 in the Journal of Urology, Dr. Walsh and colleagues reviewed data on 10,609 men who had radical prostatectomy for clinically localized prostate cancer 1978 and 2009.
Overall, 62.8% had a clinical stage of T1c or less and 76% had Gleason scores of less than 7.
Ten or more years later, 1,583 men had undetectable PSA levels, and for this group the authors determined actuarial outcomes after another 10 years - that is, 20 years after surgery - stratified by intraoperative findings.
Overall, 99 of these men (6.3%) had a subsequent biochemical recurrence. "As expected, men with organ-confined disease had a lower probability of biochemical recurrence by 20 years, while the subgroups with positive surgical margins and extra-prostatic disease had intermediate probabilities," the authors found.
The risk of biochemical recurrence also seemed to climb with increasing Gleason score within each pathological stratum.
The research team calculated that at 20 years, 11 of the men who were in the clear at 10 years would have local recurrence and six would have metastatic disease. "Although this analysis was limited by the low overall rates of metastasis, no patient with Gleason 6 disease and an undetectable PSA at 10 years after radical prostatectomy had metastasis by 20 years," the authors write.
One patient with Gleason 7 disease and seminal vesicle invasion had an elevated PSA at year 15, metastasis at year 16, and death from his disease at year 18. Another patient with Gleason 7 disease had a PSA elevation at year 20, metastasis at year 21, and death from disease at year 23, according to the paper.
"Overall these results suggest that an undetectable PSA at 10 years is a reasonable marker for surgical cure," the authors conclude.
SOURCE: http://bit.ly/kEYBXT