Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort study
Objective Although surveillance after radical prostatectomy routinely includes repeated prostate specific antigen (PSA)-testing for many years, biochemical recurrence often occurs without further clinical progression. We therefore hypothesised that follow-up can be shortened for many patients withou...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-12-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e057242.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1825205718903422976 |
|---|---|
| author | Mats Steinholtz Ahlberg Hans-Olov Adami Hans Garmo Lars Holmberg Anna Bill-Axelson Ove Andren Gunnar Steineck Jan-Erik Johansson |
| author_facet | Mats Steinholtz Ahlberg Hans-Olov Adami Hans Garmo Lars Holmberg Anna Bill-Axelson Ove Andren Gunnar Steineck Jan-Erik Johansson |
| author_sort | Mats Steinholtz Ahlberg |
| collection | DOAJ |
| description | Objective Although surveillance after radical prostatectomy routinely includes repeated prostate specific antigen (PSA)-testing for many years, biochemical recurrence often occurs without further clinical progression. We therefore hypothesised that follow-up can be shortened for many patients without increasing the risk of prostate cancer death. We investigated the long-term probabilities of PSA recurrence, metastases and prostate cancer death in patients without biochemical recurrence five and 10 years after radical prostatectomy.Design Prospective cohort study. Stratification by Gleason score (≤3+4=7 or ≥4+3=7), pathological tumour stage (pT2 or ≥pT3) and negative or positive surgical margins.Setting Between 1989 and 1998, 14 urological centres in Scandinavia randomised patients to the Scandinavian Prostate Cancer Group study number 4 (SPCG-4) trial.Participation All 306 patients from the SPCG-4 trial who underwent radical prostatectomy within 1 year from inclusion were eligible. Four patients were excluded due to surgery-related death (n=1) or salvage radiotherapy or hormonal treatment within 6 weeks from surgery (n=3).Primary outcome measures Cumulative incidences and absolute differences in metastatic disease and prostate cancer death.Results We analysed 302 patients with complete follow-up during a median of 24 years. Median preoperative PSA was 9.8 ng/mL and median age was 65 years. For patients without biochemical recurrence 5 years after radical prostatectomy the 20-year probability of biochemical recurrence was 25% among men with Gleason score ≤3+4=7 and 57% among men with Gleason score ≥4+3=7; the probabilities for metastases were 0.8% and 17%; and for prostate cancer death 0.8% and 12%, respectively. The long-term probabilities were higher for pT ≥3 versus pT2 and for positive versus negative surgical margins. Limitations include small size of the cohort.Conclusion Many patients with favourable histopathology without biochemical recurrence 5 years after radical prostatectomy could stop follow-up earlier than 10 years after radical prostatectomy. |
| format | Article |
| id | doaj-art-ae5c375486974379ae11a95bd7ac9f02 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ae5c375486974379ae11a95bd7ac9f022025-02-07T13:55:09ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2021-057242Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort studyMats Steinholtz Ahlberg0Hans-Olov Adami1Hans Garmo2Lars Holmberg3Anna Bill-Axelson4Ove Andren5Gunnar Steineck6Jan-Erik Johansson7Department of Surgical Sciences, Uppsala University, Uppsala, Sweden6 Clinical Effectiveness Research Group, Institute of Health, University of Oslo, Oslo, Norway2 Regional Cancer Center Uppsala Örebro, Uppsala, SwedenSchool of Cancer & Pharmaceutical Sciences, King`s College London, London, UK1 Department of Surgical Sciences, Uppsala University, Uppsala, SwedenDepartment of Urology, Faculty of Medicine and Health, Örebro University, Örebro, SwedenDivision of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Urology, Faculty of Medicine and Health, Örebro University, Örebro, SwedenObjective Although surveillance after radical prostatectomy routinely includes repeated prostate specific antigen (PSA)-testing for many years, biochemical recurrence often occurs without further clinical progression. We therefore hypothesised that follow-up can be shortened for many patients without increasing the risk of prostate cancer death. We investigated the long-term probabilities of PSA recurrence, metastases and prostate cancer death in patients without biochemical recurrence five and 10 years after radical prostatectomy.Design Prospective cohort study. Stratification by Gleason score (≤3+4=7 or ≥4+3=7), pathological tumour stage (pT2 or ≥pT3) and negative or positive surgical margins.Setting Between 1989 and 1998, 14 urological centres in Scandinavia randomised patients to the Scandinavian Prostate Cancer Group study number 4 (SPCG-4) trial.Participation All 306 patients from the SPCG-4 trial who underwent radical prostatectomy within 1 year from inclusion were eligible. Four patients were excluded due to surgery-related death (n=1) or salvage radiotherapy or hormonal treatment within 6 weeks from surgery (n=3).Primary outcome measures Cumulative incidences and absolute differences in metastatic disease and prostate cancer death.Results We analysed 302 patients with complete follow-up during a median of 24 years. Median preoperative PSA was 9.8 ng/mL and median age was 65 years. For patients without biochemical recurrence 5 years after radical prostatectomy the 20-year probability of biochemical recurrence was 25% among men with Gleason score ≤3+4=7 and 57% among men with Gleason score ≥4+3=7; the probabilities for metastases were 0.8% and 17%; and for prostate cancer death 0.8% and 12%, respectively. The long-term probabilities were higher for pT ≥3 versus pT2 and for positive versus negative surgical margins. Limitations include small size of the cohort.Conclusion Many patients with favourable histopathology without biochemical recurrence 5 years after radical prostatectomy could stop follow-up earlier than 10 years after radical prostatectomy.https://bmjopen.bmj.com/content/12/12/e057242.full |
| spellingShingle | Mats Steinholtz Ahlberg Hans-Olov Adami Hans Garmo Lars Holmberg Anna Bill-Axelson Ove Andren Gunnar Steineck Jan-Erik Johansson Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort study BMJ Open |
| title | Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort study |
| title_full | Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort study |
| title_fullStr | Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort study |
| title_full_unstemmed | Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort study |
| title_short | Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death: a prospective Scandinavian cohort study |
| title_sort | time without psa recurrence after radical prostatectomy as a predictor of future biochemical recurrence metastatic disease and prostate cancer death a prospective scandinavian cohort study |
| url | https://bmjopen.bmj.com/content/12/12/e057242.full |
| work_keys_str_mv | AT matssteinholtzahlberg timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy AT hansolovadami timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy AT hansgarmo timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy AT larsholmberg timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy AT annabillaxelson timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy AT oveandren timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy AT gunnarsteineck timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy AT janerikjohansson timewithoutpsarecurrenceafterradicalprostatectomyasapredictoroffuturebiochemicalrecurrencemetastaticdiseaseandprostatecancerdeathaprospectivescandinaviancohortstudy |