Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death

Abstract

Background: This report evaluated whether biochemical recurrence (BCR) as a time-dependent covariate (t) after radical prostatectomy (RP) for prostate cancer was associated with the risk of death and whether salvage therapy with radiotherapy (RT) and/or hormonal therapy (HT) can lessen this risk

Methods: This was a retrospective cohort study of 3071 men who underwent RP at Duke University between 1988 and 2008 and had complete follow-up data. A Cox regression multivariable analysis was used to determine whether BCR (t) was associated with the risk of death in men after adjusting for age, prostatectomy findings, and the use of salvage RT and/or HT.

Results: After a median follow-up of 7.4 years, 546 (17.8%) men experienced BCR and 454 (14.8%) died. The median follow-up after prostate-specific antigen (PSA) failure was 11.2 years (interquartile range, 5.8-16.0 years). BCR (t) was associated with an increased risk of death (adjusted hazards ratio [AHR], 1.03; 95% confidence interval [95% CI], 1.004-1.06 [P = .025]). In men who experienced BCR, a PSA doubling time <6 months was associated with an increased risk of death (AHR, 1.55; 95% CI, 1.15-2.1 [P = .004]); whereas a decrease in the risk of death was observed in men who received RT (AHR, 0.58; 95% CI, 0.40-0.58 [P = .002]) or HT (AHR, 0.56; 95% CI, 0.37-0.84 [P = .005]) after BCR.

Conclusions: The occurrence of BCR was found to increase the risk of death in men undergoing RP for prostate cancer, and this risk appeared to increase as the time to BCR shortened. However, the addition of RT and/or HT in men with BCR significantly lowered this risk.