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J Urol. 2018 Mar;199(3):713-718. doi: 10.1016/j.juro.2017.08.107. Epub 2017 Sep 1.

Does Early Prostate Specific Antigen Doubling Time after Radical Prostatectomy, Calculated Prior to Prostate Specific Antigen Recurrence, Correlate with Prostate Cancer Outcomes? A Report from the SEARCH Database Group.

Author information

1
Evergreen Health Hospitalist Services, Kirkland, Washington.
2
Urology Section, Department of Surgery, Veterans Affairs Medical Centers, Durham, North Carolina.
3
Urology Section, Department of Surgery, Veterans Affairs Medical Centers, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
4
Department of Urology, University of California-Los Angeles Medical Center, Los Angeles, California.
5
Urology Section, Division of Surgery, Veterans Affairs Medical Center and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia.
6
Department of Urology, University of California-San Diego Medical Center, San Diego, California.
7
Department of Urology, Oregon Health and Science University, Portland, Oregon.
8
Department of Urology, University of California-San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
9
Urology Section, Department of Surgery, Veterans Affairs Medical Centers, Durham, North Carolina; Department of Surgery, Division of Urology and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: stephen.freedland@cshs.org.

Abstract

PURPOSE:

Short prostate specific antigen doubling time following recurrence after radical prostatectomy portends a poor prognosis. Prostate specific antigen doubling time is traditionally calculated using prostate specific antigen values 0.2 ng/ml or greater. We determined whether early prostate specific antigen doubling time, calculated from the first detectable postoperative prostate specific antigen up to and including the first recurrence value, correlates with prostate cancer outcomes.

MATERIALS AND METHODS:

Cox models were used to examine the association between early prostate specific antigen doubling time and castration resistant prostate cancer, metastases, and all cause and prostate cancer specific mortality in 674 men who underwent radical prostatectomy between 1988 and 2014 and had a biochemical recurrence. Early prostate specific antigen doubling time was examined as a log transformed continuous and a categorical variable.

RESULTS:

After adjusting for multiple clinicopathological characteristics, log transformed early prostate specific antigen doubling time was not associated with any outcome. However, when early doubling time was categorized as 15 or greater, 9 to 14.9, 3 to 8.9 and less than 3 months, on multivariable analysis men with early doubling time less than 3 months were at increased risk for castration resistant prostate cancer (HR 6.20, p = 0.004), metastases (HR 5.26, p = 0.001), prostate cancer specific mortality (HR 5.06, p = 0.026) and all cause mortality (HR 1.63, p = 0.065) compared to those with an early doubling time of 15 months or greater. However, the association with all cause mortality was not significant. Those with an early prostate specific antigen doubling time of 3 to 8.9 months were at increased risk for castration resistant prostate cancer (HR 3.56, p = 0.015), all cause mortality (HR 1.67, p = 0.006) and prostate cancer specific mortality (HR 3.17, p = 0.044) but not metastases (p = 0.13).

CONCLUSIONS:

Early prostate specific antigen doubling time less than 9 months, calculated using prostate specific antigen values before and up to biochemical recurrence, is associated with an increased risk of castration resistant prostate cancer, metastases, and prostate cancer specific and all cause mortality among men with biochemical recurrence after radical prostatectomy. Early prostate specific antigen doubling time allows for risk stratification at biochemical recurrence and before prostate specific antigen doubling time is calculable, enabling these men to be referred for early aggressive secondary treatment and/or clinical trials.

KEYWORDS:

local; neoplasm recurrence; prognosis; prostate-specific antigen; prostatectomy; prostatic neoplasms

PMID:
28870860
DOI:
10.1016/j.juro.2017.08.107

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