In a nutshell
This study examined risk factors for prostate cancer recurrence more than 10 years after prostate surgery. Researchers concluded that disease recurrence rates continued to increase between 10 and 20 years after surgery. Age at surgery and increased cancer markers were found to be predictive of late disease recurrence.
Advances in treatment and early detection of prostate cancer have increased survival and led to a growing number of men living with prostate cancer. The increased life expectancy of prostate cancer survivors exposes them to the possibility of disease recurrence. Previous studies have estimated that about 15 to 45% of prostate cancer patients experience disease recurrence after prostate surgery. The majority of recurrences tend to occur within the first 3 to 5 years after surgery. The recommended frequency of prostate cancer screenings, therefore, decreases with the number of years since treatment. Identifying risk factors that could predict late disease recurrence after prostate surgery is becoming increasingly important.
Methods & findings
The aim of this study was to identify risk factors for prostate cancer recurrence more than 10 years after prostate surgery.
10,310 men who underwent prostate surgery as a first-line treatment for prostate cancer were included in the analysis. None of the men received additional treatment before or after surgery. Late disease recurrence was defined as rising PSA levels (prostate specific antigen; a protein elevated in the blood in prostate cancer) more than 10 years after surgery. Patients were followed for an average of 8.3 years.
Overall, the 10-year disease recurrence rate was 34.4%. This increased to 44% at 15 years and to 52.7% at 20 years. The average age at surgery was 64.4 years. The average PSA level at diagnosis was 7.3 mg/ml. 24.9% had a tumor stage 3 (spread into nearby tissue) or greater. About half (48.5%) had a Gleason score of 7 or greater (tissue samples indicating aggressive cancer cells).
2,480 of the men included (21.4%) followed for more than 10 years (average 12.8 years) had undetectable PSA levels 10 years after surgery. The average age at surgery among these men was 63.3 years. Average PSA at diagnosis was 7.2 ng/ml. 19% had a tumor stage of 3 or greater, and 35.1% had a Gleason score of 7 or greater. About 10% of men from this group later showed signs of recurrence. 12 died from prostate cancer.
Family history of prostate cancer, marital status, place of residence, and financial situation were not associated with an increased risk of recurrence. However, increased age at surgery, higher tumor stage, higher PSA, and higher Gleason score all significantly affected recurrence risk.
The bottom line
The authors concluded that disease recurrence rates continued to increase between 10 and 20 years after surgery. Age at surgery, PSA at diagnosis, tumor stage, and Gleason score are predictive factors for late disease recurrence. Authors recommended annual cancer screening beyond the 10th year after surgery.
Published By :
Journal of Urology
Jul 11, 2016
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