Risk of disease progression in prostate cancer patients with biochemical recurrence after prostatectomy

This article reviewed the long-term risks associated with biochemical recurrence (BCR) in prostate cancer (PCa) patients after prostatectomy. It also evaluated different factors that predict cancer progression and cancer-specific deaths.

Many PCa patients are treated with surgery to remove all or part of the prostate gland (prostatectomy). As a sign that the cancer is gone after treatment, the PSA levels usually decrease to an undetectable level. The PSA (prostate-specific antigen) is a protein made by the prostate gland whose levels usually rise in prostate disease, such as PCa. However, a big number of patients can experience a rise in PSA levels immediately or years after a prostatectomy. This rise of PSA levels without any signs of cancer is known as a biochemical recurrence (BCR). Although BCR does not always mean patients will experience signs and symptoms (clinical recurrence) of the disease, patients with BCR after prostatectomy are considered as having a great risk of recurrence (return of the cancer) and progression of the cancer. Thus, patients with BCR have been treated aggressively with secondary treatments like radiotherapy, hormonal therapy or chemotherapy in order to prevent the cancer from returning. This study evaluated the risk of cancer recurrence and progression associated with BCR in PCa patients treated only with prostatectomy. 

In this study were included 2426 PCa patients who were treated with prostatectomy and who experienced a BCR (a PSA level of 0.4ng/ml or higher). These patients were assigned to four groups according to the time it took for PSA to rise after prostatectomy (time from surgery to BCR). None of these patients received any other treatments before or after the prostatectomy. Patients were followed up for an average of 11.5 years after prostatectomy and 6.6 years after BCR.

Results show that overall, 24% of patients had clinical progression and 16% of them had died because of PCa. Also, the time from surgery to BCR did not foretell that the patient was at risk of developing a recurrence or disease progression. However, the authors of this study found that patients with early BCR had more advanced disease and greater PSA levels before surgery.

In summary, a quarter of patients who experienced BCR after prostatectomy had an actual cancer recurrence. However, the time from surgery to BCR did not predict the patients who would develop recurrence and progression of PCa. Risk of actual recurrence and progression of the disease was higher in older men with more advanced PCa and with higher PSA levels before surgery.

This article did not address the effects of other treatments on prostate cancer survival in men with BCR. Also, this study looks back at patients who have been treated in the past (retrospective study) rather than following the patients throughout their treatment and determining their outcomes (prospective study). Retrospective studies are considered to provide weak statistical evidence. 

You should visit your doctor for regular PSA checking after a prostatectomy. In case of a BCR, talk to your doctor about more tests to see if the cancer has returned and what treatment options are best for your situation.