- Published date :
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Mar 2, 2010
MedWire News: Prognostic factors for biochemical recurrence in men who have undergone radical prostatectomy should give similar results irrespective of the definition of biochemical recurrence used, research suggests.
Angel Cronin (Memorial Sloan-Kettering Cancer Center, New York, USA) and colleagues analyzed data from 5473 patients who underwent radical prostatectomy between 1985 and 2007 at a single center.
They looked at twelve different definitions of biochemical recurrence: single PSA 0.4 ng/ml or greater and increasing; single PSA 0.6 ng/ml or greater; PSA 0.2 ng/ml or greater and increasing; three consecutive PSA increases; two consecutive PSA values of 0.2 ng/ml or above; initial PSA 0.2 ng/ml or above and successive PSA greater than 0.2 ng/ml; single PSA 0.4 ng/ml or greater; two successive PSA increases with final PSA of at least 0.2 ng/ml; three successive PSA increases of at least 0.1 ng/ml; PSA 0.1 ng/ml or greater and increasing; three successive PSA increases; a single PSA of 0.2 ng/ml or greater; and any detectable PSA value.
Cronin et al report in the Journal of Urology that depending on the definition used, the probability of recurrence-free survival was 86% to 91%at 3 years and 81% to 87at 5 years.
They calculated the hazard ratios (HRs) for biochemical recurrence based on a broad range of accepted predictors. These included log PSA; biopsy Gleason grade 7 versus 6 or less, and 8 or above versus 6 or less; clinical stage T2b versus T2a or less, and T2c or greater versus T2a or less; pathology Gleason grade 7 versus 6 or less, and 8 or above versus 6 or less; extracapsular extension; seminal vesicle invasion; lymph node invasion; and possible surgical margin.
Cronin et al report that HRs tended to be smaller for the definitions of biochemical recurrence that included more patients but were fairly similar across all definitions. For example, the univariate HR was 2.1 to 2.4 for log PSA, 2.4 to 2.6 for clinical stage T2b vs T2a or less and 9.8 to 15.0 for biopsy Gleason grade 8 or greater vs 6 or less. In multivariate analysis, HRs were more homogeneous across the definitions.
The researchers comment: “These results do not imply that the clinical usefulness of the definitions is similar, only that research results do not differ importantly by definition.”
They add: “For clinical research, the definition of biochemical recurrence should be factored into comparative studies of overall recurrence probability but groups using different definitions will draw similar conclusions on prognostic factors.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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