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

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

There are no funding sources. There are no financial disclosures from any authors.

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Authors

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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Keywords

  • Radical prostatectomy
  • Biochemical recurrence
  • PSA-doubling time
  • Castration-resistant prostate cancer
  • Gleason score