• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (6)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Men's Health  • Prostate Disease  • Men's Health, Other  • Oncology  • Prostate Cancer  • Prognosis/ Outcomes  • Screening  • Less Is More  • Alert me on articles by topic  Social Bookmarking   What's this?

Edward M. Uchio, MD; Mihaela Aslan, PhD; Carolyn K. Wells, MPH; Juan Calderone, MD; John Concato, MD, MS, MPH

Arch Intern Med. 2010;170(15):1390-1395. doi:10.1001/archinternmed.2010.262

Background  Among men treated for prostate cancer, increasing prostate-specific antigen (PSA) is known as biochemical failure or biochemical recurrence (BCR). The impact of BCR on subsequent mortality is uncertain, however, especially given competing causes of death.

Methods  To describe patterns of BCR and subsequent mortality, we conducted an observational study in a community-based, "high-comorbidity" setting of 623 US veterans diagnosed as having prostate cancer from 1991 to 1995 and receiving radical prostatectomy or radiation therapy. The main outcome measures were BCR, defined as a PSA level of 0.4 ng/mL or higher (treated with surgery) or "PSA nadir + 2 ng/mL" (treated with radiation therapy), and prostate cancer mortality, determined through 2006.

Results  With 5-, 10-, and 15-year follow-up periods, respectively (for all results shown herein), the cumulative incidence of BCR after prostatectomy (n = 225) was 34%, 37%, and 37%; prostate cancer mortality among men who failed treatment (n = 81) was 3%, 11%, and 21%. Among men receiving radiation therapy (n = 398), the cumulative incidence of BCR was 35%, 46%, and 48%; prostate cancer mortality among those who failed treatment (n = 161) was 11%, 20%, and 42%. Overall, BCR was associated with an increased risk of death from prostate cancer in the study population, but the individual probability of this outcome was relatively low.

Conclusions  Biochemical recurrence is associated with increased prostate cancer mortality, yet when BCR occurs only a minority of men subsequently die of their disease. The phrase "most men die with prostate cancer, not of it" applies to elderly veterans, even after failure of primary treatment. New strategies for defining and managing treatment failure in prostate cancer are needed.

Author Affiliations: Surgical Urology (Drs Uchio and Calderone) and Medical Service (Drs Aslan and Concato and Ms Wells), and the VA Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven (Drs Uchio, Aslan, and Concato and Ms Wells); and the Departments of Surgery and Urology (Drs Uchio and Calderone) and Medicine (Drs Aslan and Concato and Ms Wells), Yale University School of Medicine, New Haven, Connecticut.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Severity of Comorbidity and Non–Prostate Cancer Mortality in Men With Early-Stage Prostate Cancer
Timothy Daskivich, Natalia Sadetsky, Sherrie H. Kaplan, Sheldon Greenfield, and Mark S. Litwin
Arch Intern Med. 2010;170(15):1396-1397.
EXTRACT | FULL TEXT  

Invited Commentary—Prostate Cancer: Doing Less Might Be More: Comment on "Severity of Comorbidity and Non–Prostate Cancer Mortality in Men With Early-Stage Prostate Cancer"
Richard J. Ablin, Oliver Sartor, and Charles L. Bennett
Arch Intern Med. 2010;170(15):1397-1399.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Invited Commentary--Prostate Cancer: Doing Less Might Be More: Comment on "Severity of Comorbidity and Non-Prostate Cancer Mortality in Men With Early-Stage Prostate Cancer"
Ablin et al.
Arch Intern Med 2010;170:1397-1399.
FULL TEXT