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PSA rise after radical prostatectomy helps predicts outcome

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The results of a new study shed light on the natural history of disease progression in men who fail to achieve an undetectable prostate-specific antigen (PSA) level after undergoing radical prostatectomy. In particular, the PSA slope, along with Gleason score, may help identify high-risk patients.

Dr. Craig G. Rogers, in the Department of Urology at Johns Hopkins Hospital in Baltimore, and colleagues assessed the clinical outcome of 160 men with a persistently detectable PSA level (greater or equal to 0.1 ng/mL) after radical prostatectomy for localized prostate cancer.Seventy-five men (47%) developed distant metastases after surgery, the team reports in the December 1st issue of Cancer. The median time from surgery to metastases was 5 years.The probability of survival free of distant metastases at 3, 5, and 10 years was 68%, 49%, and 22%, respectively.According to the team, the post-prostatectomy PSA slope and prostatectomy Gleason score can help identify those patients at increased risk of developing distant metastasis.”In particular, a PSA slope of greater than or equal to 0.05 ng/mL per month during the time period of 3-to-12 months after radical prostatectomy was particularly useful in identifying high-risk patients,” Dr. Rogers told Reuters Health.In addition, men with prostatectomy Gleason scores less than 8 had a 62% chance of remaining metastasis free 5 years after surgery compared with a 30% probability in men with Gleason scores between 8 and 10.”Our study shows that not all people who fail to achieve an undetectable PSA after radical prostatectomy are the same,” Dr. Rogers noted in comments to Reuters Health. “Some patients remain free of metastatic disease for a prolonged period (7-10 years), whereas others progress rapidly to metastatic disease in less than 3 years,” he elaborated.Summing up, Dr. Rogers said “the findings from this study have potential application in identifying those patients at higher risk of metastasis, thus helping physicians to determine the need, timing, and extent of adjuvant treatments.”(Source: Cancer 2004;101:2549-2556: Reuters Health: Oncolink: December 2004.)


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Posted On: 28 December, 2004
Modified On: 16 January, 2014

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