In men who develop PSA recurrence after surgery for prostate cancer the main determinants of clinical progression are PSADT < 10 months, time to recurrence <2 years and Gleason 8-10

In men who develop PSA recurrence after surgery for prostate cancer the main determinants of clinical progression are PSADT < 10 months, time to recurrence <2 years and Gleason 8-10

We know that 35% of men will develop a rise in PSA (>0.2 ng/mL) within 10 years after surgery – but what does this mean for the patient ? This landmark study recalled 1997 men who had undergone radical prostatectomy mostly for low to intermediate risk clinical T1-T2 disease with median 5 years follow-up (up to 15 years in some patients). The author created an algorithm for informing patients on their chance of remaining free of metastases in the event of PSA recurrence. The men with the highest chance of clinical progression (CP) after biochemical recurrence (BCR) are:

  1. PSADT
  2. Gleason score 8-10
  3. PSA recurrence

15% of men in this study (304 men) had BCR. The cancer specific survival at 10-15 years was 94%, the metastasis free survival was 82%. The time is takes from BCR to CP is 8 years, and then from CP to death is another 5 years. Therefore PSA surveillance of patients after surgery must be most frequent within the first 3 years (3 monthly PSA tests). (PSA velocity >0.35 ng/mL is also predictive of progression.)

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