Metastatic progression in men with PSA-recurrent PCa after RP: 25-year follow-up

Monday, 6 July 2009- In men with prostate specific antigen (PSA) recurrence following radical prostatectomy (RP) and no other therapy, the natural history of metastatic progression was previously described in 1999. A group of US investigators reported data reflecting up to 25 years of follow-up in this year’s ASCO Annual Meeting held in Florida, USA.

The researchers performed a retrospective analysis of 774 men treated with RP between 4/1982 and 7/2008 who developed PSA recurrence (>0.2 ng/ml) and never received adjuvant or salvage therapy. They also investigated factors influencing the development of metastases.

The results showed that the mean follow-up after RP was 8.5 y (median 8 y). Of 774 men with PSA recurrence, 295 (38%) developed metastases, and 433 had data on PSA doubling time (PSADT), forming our cohort. The mean time from RP to PSA recurrence in the entire cohort was 4.2 y (median 3 y). In those who developed metastases, the mean time from PSA recurrence to metastasis was 3.1 y (median 2 y).

The mean PSA at the time of metastasis was 90.3 ng/ml (median 31.4 ng/ml). In Cox regression analysis: PSADT, Gleason score, and time to PSA progression were predictive of the development of metastases (Table). In Kaplan-Meier survival analysis, the median actuarial time from PSA recurrence to metastasis was 10 y (95% CI 9 - 15 y). Median actuarial metastasis-free survival from PSA recurrence for men with PSADT <3 mo, 3 - 8.9 mo, 9 - 14.9 mo, and >15 mo was 1 y (95% CI 0 - 1 y), 4 y (95% CI 2 - 6 y), 9 y (95% CI 7 - 13 y), and 15 y (95% CI 12 - 20 y), respectively.

"PSADT, Gleason score, and time to PSA progression are strong independent predictors of metastasis-free survival in men with PSA-recurrent prostate cancer," the researchers concluded. "These data facilitate patient counselling and logical risk-based treatment planning. They also provide the background for appropriate selection of patients, treatments, and endpoints for clinical trials."



Multivariable Cox proportional hazards regression analysis





Hazard Ratio (95% CI)









    < 3 mo


20.6 (11.2-38.1)




    3-8.9 mo


6.3 (3.8-10.7)




    9-14.9 mo


2.4 (1.3-4.4)




    >15 mo


1 [Reference]



Gleason score






2.0 (1.4-3.0)






1 [Reference]



Time to PSA progression




    >3 y


0.3 (0.2-0.4)




    <3 y


1 [Reference]




Source: E. S. Antonarakis, B. J. Trock, Z. Feng, et al., Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, Michigan, USA; "The natural history of metastatic progression in men with PSA-recurrent prostate cancer after radical prostatectomy: 25-year follow-up," Oral Presentation, ASCO Annual Meeting, Orlando, Florida, USA; J Clin Oncol 27:15s, 2009 (suppl; abstr 5008).

Edited by: JV

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