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Type of patients in whom biochemical recurrence after radical prostatectomy can be observed without salvage therapy

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Abstract

Purpose

To examine the prognosis after BCR with and without salvage therapy, including radiation and/or androgen deprivation.

Methods

The study population consisted of 431 patients, all of whom underwent radical prostatectomy and developed BCR (PSA > 0.2 ng/mL). According to the two risk factors [Gleason score ≥ 8 and PSA-doubling time (DT) < 6 months], we divided the patients into two groups. The high/intermediate-risk group consisted of patients with both or one risk factor. On the other hand, patients with neither factor were in the low-risk group. We set the starting point at the timing of BCR, and the endpoints were development to castration-resistant prostate cancer (CRPC) and cancer-specific death.

Results

During the mean follow-up period of 8.3 years after BCR, CRPC was observed in 49 patients (11.4%), and 21 patients (4.9%) died due to prostate cancer. We first divided the 191 high/intermediate-risk patients according to the PSA level (PSA < 1.0 ng/mL, PSA 1.0–4.0, and PSA > 4.0 or no therapy) at the initiation of salvage therapy, including radiation and/or androgen deprivation. We found that delayed (PSA > 4.0 ng/mL) or no salvage therapy was significantly associated with CRPC and cancer-specific death. In the 240 low-risk patients, Kaplan–Meier curves demonstrated no significant difference in CRPC-free survival or cancer-specific survival within 10 years from the timing of BCR.

Conclusions

Observation after BCR without salvage therapy or delayed administration may be an option for low-risk patients with a Gleason score ≤ 7 and PSA-DT ≥ 6 months when their life expectancy is within 10 years.

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Funding

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Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan

    Kazuhiro Matsumoto, Masayuki Hagiwara, Takeo Kosaka, Nobuyuki Tanaka, Toshikazu Takeda, Shinya Morita, Ryuichi Mizuno, Toshiaki Shinojima, Hiroshi Asanuma & Mototsugu Oya

  2. Department of Urology, Tokyo Saiseikai Central Hospital, Mita 1-4-17, Minato-ku, Tokyo, 108-0073, Japan

    Naoya Niwa

  3. Department of Urology, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kawasaki, 210-0013, Japan

    Satoshi Hara

Authors
  1. Kazuhiro Matsumoto
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  2. Naoya Niwa
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  3. Masayuki Hagiwara
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  4. Takeo Kosaka
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  5. Nobuyuki Tanaka
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  6. Toshikazu Takeda
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  7. Shinya Morita
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  8. Ryuichi Mizuno
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  9. Toshiaki Shinojima
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  10. Satoshi Hara
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  11. Hiroshi Asanuma
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  12. Mototsugu Oya
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Contributions

KM project development, data collection, data analysis, and manuscript writing. NN data collection. MH data collection. TK manuscript editing. NT manuscript editing. TT manuscript editing. SM: manuscript editing. RM manuscript editing. TS manuscript editing. SH: data collection. HA manuscript editing. MO manuscript editing and supervision.

Corresponding author

Correspondence to Kazuhiro Matsumoto.

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This retrospective study was conducted after receiving approval from the institutional review board.

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Matsumoto, K., Niwa, N., Hagiwara, M. et al. Type of patients in whom biochemical recurrence after radical prostatectomy can be observed without salvage therapy. World J Urol 38, 1749–1756 (2020). https://doi.org/10.1007/s00345-019-02970-w

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  • DOI: https://doi.org/10.1007/s00345-019-02970-w

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