Prostate specific antigen doubling time as a surrogate end point for prostate cancer specific mortality following radical prostatectomy or radiation therapy

Anthony V. D'Amico, Judd Moul, Peter R. Carroll, Leon Sun, Deborah Lubeck, Ming Hui Chen, Peter Iversen, Edward P. Gelmann, William R. Sellers

Research output: Contribution to journalArticlepeer-review

138 Scopus citations

Abstract

Purpose: A short posttreatment prostate specific antigen (PSA)-doubling time (DT) following radical prostatectomy or radiation therapy was evaluated as a surrogate end point for prostate cancer specific mortality (PCSM). Materials and Methods: Baseline, treatment and followup information was compiled on a cohort of 8,669 patients with prostate cancer treated with surgery (5,918) or radiation (2,751) from January 1, 1988 to January 1, 2002 for clinical stage T1c-4NxMo prostate cancer, forming the study cohort. Cox regression analysis was used to test whether Prentice criteria were violated in this cohort. Results: After PSA defined recurrence PSA-DT less than 3 months and the specific value of PSA-DT at 3 months or greater were statistically significantly associated with time to PCSM and with time to all cause mortality after PSA defined recurrence (each Cox p <0.001). Treatment received was not statistically significant associated with time to PCSM following PSA defined recurrence in patients with PSA-DT less than 3 months (Cox p = 0.90) and in patients with PSA-DT 3 months or greater (Cox p = 0.28). Furthermore, after PSA defined recurrence PSA-DT less than 3 months was statistically significantly associated with PCSM (HR 19.6, 95% CI 12.5 to 30.9). Conclusions: Posttreatment PSA-DT appears to be a surrogate end point for PCSM following surgery or radiation therapy. We recommend that consideration should be given to enrollment onto a clinical trial and/or initiating androgen suppression therapy at the time of PSA defined recurrence when PSA-DT is less than 3 months to delay the imminent sequelae of metastatic bone disease.

Original languageEnglish (US)
Pages (from-to)S42-S47
JournalJournal of Urology
Volume172
Issue number5 II
DOIs
StatePublished - Nov 2004
Externally publishedYes

Keywords

  • Prostate
  • Prostate-specific antigen
  • Prostatic neoplasms
  • Survival

ASJC Scopus subject areas

  • Urology

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