Time from surgery to recurrence and how it affects survival

This study looked at men who had their prostate removed after diagnosis of prostate cancer. The study evaluated the time from surgery to biochemical recurrence, and whether this period of time is associated with survival or certain cancer characteristics.

One of the initial treatments for prostate cancer is a radical prostatectomy (surgery to remove the prostate gland). When the removed cancer is examined under the microscope it is assigns a Gleason score, which indicates how aggressive the tumor is. A score of 6 or less is considered low grade, 7 is considered intermediate grade, and 8-10 is considered a high grade, aggressive cancer.

After surgery, doctors routinely test for prostate specific antigen (PSA) in the blood. PSA is a molecule produced by the prostate, and concentrations go up when a prostate cancer is growing. When high PSA levels reappear in the blood after treatment of the cancer, it is considered a preliminary sign of cancer recurrence, and is referred to as biochemical recurrence (BCR).

Medical records of 2116 men who underwent a radical prostatectomy were analyzed in this study. Follow up after surgery averaged 10.3 years. 33% of all patients experienced BCR. 82% of these experienced BCR less than 5 years after surgery. Only 66 (10%) of the patients who experienced BCR eventually died from prostate cancer during the study period. In high-risk patients (patients with an aggressive, high Gleason score cancer, or with a cancer that had spread to other tissues before removal), the more time from surgery it took BCR to appear, the better the survival rate was. Patients with less aggressive cancers (low Gleason score, or with the cancer confined to the prostate) had very good survival rates regardless of when they experienced BCR. This implies that low-risk patients experiencing BCR might not require any additional aggressive treatment.

Time to BCR for low-risk prostate cancer patients after surgery does not appear to have an effect on survival. For patients with high-risk prostate cancers, the longer the time to BCR the better the prognosis.

This study did not specify the cancer characteristics of each patient, nor did it mention any additional treatments received other than surgery.

Consult with your physician about screening for cancer recurrence after surgery, and the best course of action if biochemical recurrence is detected.