PSA doubling time (PSADT) and proximal PSA value predict metastasis-free survival (MFS) in men with biochemically recurrent prostate cancer (BRPC) after radical prostatectomy (RP).

Abstract

5075 Background: We previously reported a relationship between PSADT and MFS in BRPC post RP (Pound 1999; Freedland 2007; Antonarakis 2012). In men with PSADT<12 months, who are at high risk of lethal PCa, we sought to identify a PSA cutpoint (proximal PSA; PP) that indicates the imminent emergence of metastasis (M+). In this report we combined Center for Prostate Disease Research and Johns Hopkins (CPDR/JHU) databases to investigate the association of the PP value on MFS in men with BRPC and PSADT <12 mos. Methods: In the CPDR/JHU RP database (31,296), 513 men with BCR (>0.2ng/ml) with PSADT <12 mos who received no adjuvant/salvage ADT/RT were prospectively followed until radiological evidence of M+ are included in this analysis. All patients were evaluated yearly with >1 PSA and scans at regular intervals until M+. Associations with MFS were compared using logrank test and Cox regression. The PP is the most recent value >6 months prior to M+/censor. Results: M+ occurred in 218 of 513 patients with BRPC (median follow up 9 years). Risk of M+ increased successively for PSADT 6.0-7.5, 4.5-6, 3.0-4.5, and <3.0 months, adjusted for pT stage and Gleason score. PP ≥10ng/ml significantly increased risk of M+ in pts with PSADT <12 mos, regardless of PSADT subgroup, hazard ratio=2.95, p<.0001. Median MFS was 4.0 years at PP >10ng/ml vs 20 years at PP <10ng/ml. Table 1 shows median MFS and 3, 5, and 7 year MFS rates in subgroups with PSADT <3 and 3.01-6 months representing the highest risk groups. Conclusions: In men with PSADT<12 months, PSADT subgroups <7.5 months and PP >10ng/ml are independent predictors of MFS, adjusted for pT stage and Gleason score. PP ≥10ng/ml further define risk of M+ in BRPC with PSADT<12 months. These data can assist physicians in patient counseling and clinical trial design. [Table: see text]