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Death in Patients With Recurrent Prostate Cancer After Radical Prostatectomy: Prostate-Specific Antigen Doubling Time Subgroups and Their Associated Contributions to All-Cause Mortality

Stephen J. Freedland, Elizabeth B. Humphreys, Leslie A. Mangold, Mario Eisenberger, Frederick J. Dorey, Patrick C. Walsh, Alan W. Partin

From the Departments of Urology and Oncology, The James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD; Department of Surgery, Veterans Administration Medical Center Durham; Division of Urologic Surgery and Duke Prostate Center, Departments of Surgery and Pathology, Duke University School of Medicine Durham, NC; and The Biostatistics Core, University of Southern California, Keck School of Medicine at Childrens Hospital Los Angeles, Los Angeles, CA

Address reprint requests to Stephen Freedland, MD, DUMC Box 3850, Duke University Medical Center, Durham, NC 27710; e-mail: steve.freedland{at}duke.edu

Purpose: Among patients with biochemical recurrence after radical prostatectomy, we found previously that postoperative prostate-specific antigen doubling time (PSADT) was associated with risk of prostate cancer death. However, given the small number of patients in the highest risk PSADT subgroup, it is unclear which PSADT subgroups contribute the greatest to prostate cancer–specific death and how this influences all-cause mortality.

Patients and Methods: This study was a retrospective analysis of 379 patients treated with radical prostatectomy between 1982 and 2000 who had a biochemical recurrence and PSADT data available. Mean and median follow-up after surgery was 11.4 (standard deviation, 5.4) and 11.0 years, respectively (range, 1.6 to 23.0 years).

Results: Shorter PSADT was significantly associated with prostate cancer–specific and all-cause mortality (P < .001). Although patients with a PSADT less than 3 months were at the greatest risk of death, because of the limited number of patients in this group, they accounted for only 13% of prostate cancer deaths at 15 years after biochemical recurrence, whereas patients with an intermediate PSADT (3.0 to 8.9 months) accounted for 58% of all prostate cancer deaths. Among patients with a PSADT less than 15 months, prostate cancer accounted for 90% of all deaths. Only patients in the slowest PSADT subgroup ( 15 months) had a greater risk of competing-causes mortality compared with that from prostate cancer.

Conclusion: Among a select cohort of young, healthy patients with PSA recurrence after radical prostatectomy and a PSADT less than 15 months, prostate cancer accounted for an estimated 90% of all deaths by 15 years after recurrence. The majority of prostate cancer deaths occurred among patients with an intermediate PSADT (3.0 to 8.9 months).

Supported by the National Institute of Health/National Cancer Institute–SPORE Grant No. P50CA58236, The Prostate Cancer Foundation, the Department of Defense Prostate Cancer Research Program, and the American Urological Association Foundation Astellas Rising Star in Urology Award.

Views and opinions of, and endorsements by the author(s) do not reflect those of the US Army or the Department of Defense.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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