How the sites of tumors can affect prostate cancer patient survival

The authors determined the factors that predict cancer recurrence (return of cancer) and how they can affect overall survival in prostate cancer patients. 

One of the most common treatments for prostate cancer is the surgical removal of the prostate gland (prostate surgery). However, 10% of patients who undergo prostate surgery have cancer in their lymph nodes (sites that hold the immune cells), known as node-positive prostate cancer. These patients may have increased cancer recurrence and cancer-specific mortality. Cancer-specific mortality is defined as death from the specific cancer following treatment. These patients can also have an increased risk of biochemical recurrence. This is when patients experience an elevated level of prostate specific antigen (PSA- a protein produced by the prostate gland and is elevated in prostate cancer patients) after treatment with surgery or radiation.

Not much is known on the patterns of cancer recurrence in patients with node-positive prostate cancer and it needs to be established. 

The aim of this study was to determine the sites of cancer recurrence and their effect on survival in prostate cancer patients.

Overall, 800 patients were included in this study with an average follow-up time of 76.7 months. All patients had node-positive prostate cancer and had undergone surgery to remove the affected lymph nodes.

Of all those who experienced cancer recurrence, 30.5% had return of cancer to the original site (local) or to the lymph nodes and 42.1% had cancer relapse in bones and joints (skeletal). Overall,  370 patients experienced biochemical recurrence after prostate surgery, of whom, 49.5% patients had recurrence of cancer.

Patients with shorter time from the surgery until biochemical recurrence had an increased risk of local recurrence. Patients with a Gleason score of 9-10 (scoring system that compares cancerous cells and normal cells) had over 3 times increased risk of experiencing systemic (all over the body) recurrence compared to those who had lowers scores. Patients who received a PET/CT scan (imaging technology used to identify diseased tissue) had over 3 times increased risk of experiencing systemic recurrence compared to those who received other imaging techniques.

Survival without cancer-specific death was significantly influenced by the sites of the cancer recurrence. Overall, 58.8% patients survived without cancer-specific death for a 5-year period. This survival rate was 79.3% for cancer relapse in lymph nodes, 76.3% for cancer recurrence in the stomach lining, 50.8% for skeletal cancer and 35.3% for cancer relapse in chest or abdomen. 

The authors concluded that node-positive prostate cancer patients with cancer recurrence in lymph nodes had better survival than patients with cancer recurrences in skeletal, abdomen or chest.

Further studies are needed to determine optimal post-operative treatment. 

Please consult your doctor for the best treatment option for recurrent prostate cancer.