Three factors identify prostate Ca patients who need further treatment

Three risk factors—PSA doubling time, Gleason score, and time from surgery to biochemical recurrence—can be used to determine whether to treat patients aggressively or carefully following radical prostatectomy for prostate cancer, according to a study published last week in JAMA (2005; 294:433-9).

Stephen J. Freedland, MD, and colleagues from The Brady Urological Institute at Johns Hopkins, Baltimore, have concluded that patients with a PSA doubling time of less than 3 months had a median survival of 6 years. Patients with a PSA doubling time of less than 3 months, biochemical recurrence 3 years or less after surgery, and a pathologic Gleason score of 8 to 10 had a median survival of 3 years. Patients with a PSA doubling time of 15 or more months and a biochemical recurrence more than 3 years after surgery had a 100% prostate cancer-specific survival.

Using the three risk factors, the researchers then constructed tables to estimate the risk of prostate cancer-specific survival at 5, 10, and 15 years after biochemical recurrence.

"We hope the tables will be useful to patients and their physicians for assessing the risk of death from prostate cancer following recurrence after surgery and guide the need for additional treatments," Dr. Freedland said.

The study included 379 men who had undergone radical prostatectomy between 1982 and 2000 and who had a biochemical recurrence. The average follow-up after surgery was 10.3 years.