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. 2007 Apr;51(4):940-7; discussion 947-8.
doi: 10.1016/j.eururo.2006.10.045. Epub 2006 Oct 30.

The natural history of noncastrate metastatic prostate cancer after radical prostatectomy

Ofer Yossepowitch  1 , Fernando J Bianco Jr, Scott E Eggener, James A Eastham, Howard I Scher, Peter T Scardino
Affiliations

The natural history of noncastrate metastatic prostate cancer after radical prostatectomy

Ofer Yossepowitch et al. Eur Urol. 2007 Apr.

Abstract

Objectives: To characterise the natural history of metastatic prostate cancer after radical prostatectomy (RP) in patients followed expectantly for rising prostate-specific antigen (PSA) (noncastrate metastases).

Methods: Cox proportional hazards analyses were used to assess predictors of survival among 95 patients who developed clinically detectable noncastrate metastases after RP. The initial metastatic phenotype was characterised as minimal (nodal or axial skeletal involvement) or extensive (appendicular skeletal involvement or visceral metastases). Estimates of survival after diagnosis of metastases were generated with the Kaplan-Meier method.

Results: Median disease-specific survival from diagnosis of noncastrate metastases was 6.6 yr (95% confidence interval [CI], 5.2, 7.9). The initial site of metastatic disease was bone, lymph node, and viscera in 63%, 36%, and 6% of patients, respectively. Thirteen patients (14%) had extensive disease at their first metastatic manifestation. Longer PSA doubling time in the rising PSA state (hazard ratio [HR] 0.8 for each month increase in doubling time; 95%CI, 0.67-0.94) and the initial metastatic phenotype (HR 0.3 for minimal vs. extensive disease; 95%CI, 0.1-0.6) were associated with improved survival. The prostatectomy Gleason score, lymph node status at RP, PSA level at diagnosis of metastases, and interval from surgery to diagnosis of metastases did not correlate with outcome.

Conclusion: Men who develop noncastrate metastases after RP may have a durable survival. Favourable prognostic indicators include longer PSA doubling time preceding diagnosis of metastases and initial involvement of axial skeleton or lymph nodes.

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Conflict of interest statement

Conflicts of interest

I hereby certify that all authors have made a substantial contribution to the information or material submitted for publication and have read and approved the final manuscript. The manuscript or portions thereof are not under consideration by another journal or electronic publication and have not been previously published.

Figures

Fig. 1
Fig. 1
Prostate cancer-specific survival after entry into the noncastrate metastatic disease state, among 95 patients who had undergone radical prostatectomy.
Fig. 2
Fig. 2
Prostate cancer-specific survival after development of noncastrate metastases, stratified by prostate-specific antigen doubling time.
Fig. 3
Fig. 3
Estimates of 5-yr disease-specific survival among patients developing noncastrate metastases after radical prostatectomy. Three patients presenting with extensive disease and a prostate-specific antigen doubling time >3 mo are excluded from the chart. DSS = disease-specific survival; PSA DT = prostate-specific antigen doubling time. Values in parentheses represent 95% confidence intervals (CIs).
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