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Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy
- Source :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 23(28)
- Publication Year :
- 2005
-
Abstract
- Purpose We evaluated predictors of prostate cancer–specific mortality (PCSM) after prostate-specific antigen (PSA) failure after radical prostatectomy (RP) or radiation therapy (RT). Patients and Methods A total of 1,159 men with clinically localized prostate cancer treated with RP (n = 498) or RT (n = 661) developed PSA failure, and they formed the study cohort. Competing risk regression analyses were used to evaluate whether previously identified predictors of time to metastasis, including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure, could also predict time to PCSM after PSA failure. The cumulative incidence method was used to estimate PCSM after PSA failure. Results A post-RP PSA-DT of less than 3 months (hazard ratio [HR], 54.9; 95% CI, 16.7 to 180), a post-RT PSA-DT of less than 3 months (HR, 12.8; 95% CI, 7.0 to 23.1), and a biopsy Gleason score of 8 to 10 (HR, 6.1; 95% CI, 3.4 to 10.7) for patients treated with RT were significantly associated with PCSM. Post-RP estimated rates of PCSM 5 years after PSA failure were 31% (95% CI, 17% to 45%) v 1% (95% CI, 0% to 2%) for patients with PSA-DT of less than 3 months v ≥ 3 months. Post-RT estimated rates of PCSM 5 years after PSA failure were 75% (95% CI, 59% to 92%) v 35% (95% CI, 24% to 47%) for patients with a biopsy Gleason score of ≥ 8 v ≤ 7, respectively, and PSA-DT of less than 3 months; these rates were 15% (95% CI, 0.8% to 28%) v 4% (95% CI, 1% to 6%), respectively, for patients with a PSA-DT ≥ 3 months. Conclusion Patients at high risk for PCSM after PSA failure can be identified based on post-RP PSA-DT or post-RT PSA-DT and biopsy Gleason score. These parameters may be useful in identifying patients for a randomized trial evaluating hormonal therapy with or without docetaxel.
- Subjects :
- Male
Cancer Research
medicine.medical_specialty
Databases, Factual
medicine.medical_treatment
Biopsy
Urology
urologic and male genital diseases
Risk Assessment
Cohort Studies
Prostate cancer
PSA Failure
Prostate
Predictive Value of Tests
medicine
Humans
Cumulative incidence
Aged
Neoplasm Staging
Retrospective Studies
Gynecology
Aged, 80 and over
Prostatectomy
business.industry
Hazard ratio
Prostatic Neoplasms
Middle Aged
Prostate-Specific Antigen
medicine.disease
Prognosis
Combined Modality Therapy
medicine.anatomical_structure
Oncology
Docetaxel
Hormonal therapy
business
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 0732183X
- Volume :
- 23
- Issue :
- 28
- Database :
- OpenAIRE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....7b7a255835e5744e5a78f256025625be