Prostate cancer death related to BCR, but rare outcome
MedWire News: US research shows that biochemical recurrence (BCR) of prostate cancer after treatment is associated with prostate cancer mortality, although only a minority of elderly men with recurrence will die from the disease.
"The phrase 'most men will die with prostate cancer, not of it' applies to elderly veterans, even after failure of primary treatment," say John Concato from VA Conecticut Healthcare System in West Haven, USA, and colleagues.
The team investigated BCR patterns among 623 US veterans, aged an average of 70 years and treated with radical prostatectomy (RP, n=225), or radiotherapy (RT, n=398) for localized prostate cancer, with particular regard for prostate cancer mortality.
A detectable prostate-specific antigen (PSA) level after RP implies residual or recurrent prostate cancer, explain Concato et al. Here, they defined BCR after RP as a PSA level of 0.2 ng/ml or higher, and after RT as a PSA of 2.0 ng/ml or more above the absolute nadir.
During follow-up ranging from 11 to 16 years, 48 (12%) of 387 (62%) deaths in the cohort were attributed to prostate cancer.
Among RP patients, the cumulative incidence of BCR was 34%, 37%, and 37%, after 5, 10, and 15 years of follow-up, respectively. The corresponding BCR rates among RT patients were a respective 35%, 46%, and 48%.
Almost all patients who did not experience BCR were still alive after 15 years with cumulative prostate cancer mortality rates of 0% and 1% for RP and RT patients, respectively.
By contrast, in RP and RT patients who did experience BCR, 5-, 10-, and 15-year cumulative mortality rates were 3%, 11%, and 21%, and 11%, 20%, and 42%, respectively.
Multivariate analysis, adjusted for competing variables such as age, comorbidity, and histologic disease grade confirmed a statistically significant association between BCR and prostate cancer mortality.
"Yet even among the treatment groups with biochemical failure, death caused by prostate cancer was seen in less than half of men," emphasize the researchers.
They conclude, in Archives of Internal Medicine: "The relatively low probability of prostate cancer mortality may provide some reassurance, and perhaps improve the quality of life, among men facing this situation."
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By Sarah Guy