Are you at risk of cancer recurrence after prostate surgery?

The authors aimed to determine patients who were at risk of cancer returning after surgery for prostate cancer.

Radical prostatectomy involves surgically removing the prostate from patients that have prostate cancer. It is used as a treatment option in early stage prostate cancer where the tumor has not spread outside of the prostate.

Biochemical recurrence is a rise in prostate specific antigen (PSA – protein in the blood that is elevated when prostate cancer is present) in patients after treatment with surgery or radiation. This may signify prostate cancer recurrence (return of the prostate cancer).

The aim of this study was to determine which patients were more at risk of biochemical recurrence following radical prostatectomy.

11, 636 patients were used in this study. 1, 471 patients experienced recurrence where 520 had early recurrence (less than a year after treatment) and 951 had late recurrence. Follow-up time was between 4 and 6 years.

Patients who experienced early recurrence had higher PSA levels, Gleason scores (scoring system that compares the differences between normal and cancer cells) and risk classification (standard classification system that determines low, intermediate and high-risk cases).

Early recurrence patients had an increased risk of experiencing  tumor spread (33.1%) compared to late recurence patients (18.1%), and increased risk of experiencing cancer-specific mortality (patient dies from prostate cancer) (24%) compared to late recurrence patients (13.1%).

Patients classified as high-risk (PSA of more than 20ng/ml, Gleason pattern of 4-5) were nearly twice as likely to experience cancer spreading to a prostate nerve (36.7%) compared to late recurrence patients (22.3%). Early recurrent patients also had an increased risk of experiencing tumor growth and spread outside of the prostate (48.1%) compared to late recurrence patients (8.6%) and had higher cancer-specific mortality rates (24.1%) compared to late recurrence patients (4%).

The odds of experiencing early recurrence after radical prostatectomy were 3.17 times higher in patients with Gleason patterns of 5, or more than 4 tumors with a pattern of 4 (indicates large tumor volume and cancer growth) compared to patients with lower patterns. The risk of tumor spread was 3 times higher and the risk of cancer-specific mortality was 3.27 times higher in patients with Gleason patterns of 4-5 than in patients with lower Gleason patterns.

The odds of experiencing early recurrence in high-risk patients who had an undetectable PSA but high Gleason patterns of between 4-5 were 2.81 times higher when compared to patients with low Gleason patterns.

The authors conclude that patients classified as high-risk were more likely to experience biochemical recurrence following radical prostatectomy. This may help to identify patients who will benefit from additional treatment. 

This study was conducted at a single institution which may have biased the results.

If you are considering radical prostatectomy and have concerns about cancer recurrence please consult your doctor.