Biochemical Failure Does NOT Predict Survival

After Radical Prostatectomy

Nov 18 (Reuters Health) - Patients in whom prostate specific antigen (PSA) levels increase after radial prostatectomy for localized prostate cancer have a 10-year survival equivalent to that seen in patients with low PSA results. These findings suggest that the clinical significance of PSA should be reassessed, according to a report published in the November issue of Urology.

Dr. Faiyaaz M. Jhaveri and colleagues from the Cleveland Clinic Foundation in Ohio studied overall survival rates in 1,132 patients undergoing radical prostatectomy between 1986 and 1998. Their aim was to determine whether or not biochemical failure--defined as a PSA concentration of at least 0.2 ng/mL--influenced overall survival in these individuals.

The authors report that biochemical failure occurred in 213 patients (19%), 99 of whom were given second-line treatment involving hormone ablation and/or radiation therapy.

The 10-year survival rate was 88% in patients with biochemical failure, compared with a rate of 93% in patients without biochemical failure. The study team also found a similar 10-year survival rate of 86% in patients receiving second-line therapy.

According to the paper, these rates were not significantly different when patients were "...compared by age older than 65 years, preoperative PSA greater than 10 ng/mL...Gleason score 7 or greater, clinical stage T2b-3, presence of extracapsular extension, positive surgical margins, and seminal vesicle invasion."

Dr. Jhaveri's team notes that in patients with biochemical failure the 10-year metastasis-free survival was 74%. They also point out that "[t]he overall survival rate for patients with distant metastasis (56%) was markedly lower...than for those without distant metastasis."

The study team concludes that "[a]lthough PSA-free survival is widely used as an endpoint and indicator of the success or failure of surgery, the clinical significance of [biochemical failure] needs be evaluated with longer follow-up of these patients." They add, "[I]t may be comforting to the patient that [biochemical failure] does not translate into death from prostate cancer at 10 years.

Urology 1999;54:884-890. Thanks to Medscape

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