The risk of prostate cancer death in men who fail surgery for prostate cancer is based on time to failure, PSA doubling time and Gleason grade
After surgery for prostate cancer the PSA level should be undetectable at 0.2 ng/mL over several readings several months apart. An important point is that from BCR to clinical progression (CP) is takes 8-10 years, and then from CP to death it takes another 5 years. This means that BCR is not relevant to men with a limited life expectancy as their disease will never become a clinical problem. This means that adjuvant treatment such as radiotherapy after surgery will most benefit those with a long life expectancy and should not be offered to men with limited life expectancy. This study concludes there are 3 main factors that increase the risk of prostate cancer death:
- Early biochemical recurrence, within 3 years from surgery
- PSA doubling time, PSADT less than 3 to 9 months
- Gleason grade 8-10.
Since secondary treatments are associated with reduced quality of life they should be targeted at men with long life expectancy. The question of when to commence hormone therapy in men with BCR and/or clinical progression is unanswered. Another important variable is PSA velocity > 0.35 ng/mL is predictive of risk of disease progression.