Survival analysis of patients with biochemical relapse after radical prostatectomy treated with androgen deprivation: Castration-resistance influential factors

Authors

  • Ruben Algarra University of Navarra Clinic
  • Mateo Hevia University of Navarra Clinic
  • Antonio Tienza University of Navarra Clinic
  • Imanol Merino University of Navarra Clinic
  • Jose Maria Velis University of Navarra Clinic
  • Javier Zudaire University of Navarra Clinic
  • Jose Enrique Robles University of Navarra Clinic
  • Ignacio Pascual University of Navarra Clinic

DOI:

https://doi.org/10.5489/cuaj.1665

Keywords:

Prostate Cancer, Radical prostatectomy, Biochemical recurrence, Castration resistance, Androgen deprivation therapy, PSA doubling time.

Abstract

Introduction: We evaluate the prognosis of patients with biochemical recurrence (BCR) treated with androgen deprivation therapy (ADT) and to determine the influential factors to castration resistance (CR) and death.

Methods: From a series of 1310 patients with T1-T2 prostate cancer treated with radical prostatectomy between 1989 and 2012, 371 had BCR. Patients with lymph node involvement were excluded. We analyzed only the 159 treated with salvage ADT. At the end of the study, 77 (48%) had developed CR.

Results: The median follow-up to CR was 9.2 years. The CR-resistant-free survival (RFS) was 76 ± 3%, 62 ± 3% and 43 ± 9% in 5, 10 and 15 years, respectively. The RFS median time was 14 years. In the multivariate study, the prostate-specific antigen (PSA) doubling time (PSA-DT) was <6 months (p = 0.01) (hazard ratio [HR] 3;95% confidence interval [CI] 1.4-6.8, p = 0.007); seminal vesicle involvement (HR 3.1; 95% CI 1.5-6.2, p = 0.01) and PSA velocity in ng/mL/year (HR 1.3; 95% CI 1.1-1.5, p = 0.002) with better cut-off points of 0.84 ng/mL/year (p = 0.04) (HR 4; 95% CI 1.7-9.4, p = 0.001) were influential variables. Specific survival (SS) at 5, 10 and 15 years since surgery was 96 ± 1, 85 ± 2 and 76 ± 4, respectively. The time of CR to death was 30 ± 6% at 5 years, with the median at 3.2 years. In the multivariate only Ki 67 (HR1.04; 95% CI 1.005-1.08, p = 0.02) had an independent influence.

Conclusions: In BCR patients treated with ADT, the median to CR was 14 years. PSA-DT <6 months, PSA velocity (ng/mL/year) and seminal vesicle involvement were influential variables. From the CR, the median time to death was 3.2 years. Ki-67 marker was an independent influence.

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Published

2014-05-21

How to Cite

Algarra, R., Hevia, M., Tienza, A., Merino, I., Velis, J. M., Zudaire, J., Robles, J. E., & Pascual, I. (2014). Survival analysis of patients with biochemical relapse after radical prostatectomy treated with androgen deprivation: Castration-resistance influential factors. Canadian Urological Association Journal, 8(5-6), e333–41. https://doi.org/10.5489/cuaj.1665

Issue

Section

Original Research