BCR patients with a PSADT greater than 9 months, for example, have a high probability of long-term, metastasis-free survival and overall survival. One of the strongest predictors of metastasis and death is the PSA doubling time (PSADT), a mathematical determination of the length of time (in months) needed for the PSA level to double in a given patient. Not all patients with BCR prostate cancer have the same prognosis, and stratification of patients into appropriate risk groups is essential. Reasonable options include: 1)salvage radiation therapy, if progression has occurred after prostatectomy 2) observation with close surveillance 3) androgen deprivation therapy (ADT), either intermittent or continuous, initiated upon PSA recurrence or deferred until after clinical/radiographic progression or 4) enrollment in investigational clinical trials. 6 There is currently no consensus regarding optimal management of this disease state. 3 However, 20–40% of patients undergoing RP 4,5 and 30–50% of patients undergoing RT will experience biochemical recurrence within 10 years. Radical prostatectomy (RP), which is used in approximately 75,000 newly diagnosed prostate cancer cases each year (30% of those diagnosed), 2 can cure appropriately-selected patients with localized disease, as can external-beam radiation therapy (RT) and brachytherapy, which are used in approximately 60,000 newly diagnosed cases (25% of those diagnosed).

In this generally healthy population, effective management requires that physicians evaluate PSA levels, as well as clinical and radiologic indicators, in order to balance the morbidity and efficacy of proposed treatments against the risks of metastatic progression. Physicians treating patients with BCR face a difficult set of decisions in attempting to delay the onset of metastatic disease and death while avoiding over-treating patients whose disease may never affect their overall survival or quality of life. 1 Many more patients will experience rising prostate-specific antigen (PSA) levels following local therapy, a condition known as biochemical recurrence (BCR Figure 1). Antonarakis, MD, Assistant Professor of Oncology, Prostate Cancer Research Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, CRB1-1M45, Baltimore, MD 21231 Phone: 44 Fax: 41 E-mail: than 12% of the 241,700 men expected to have been diagnosed with prostate cancer in the United States in 2012 will die from this disease. Paller and Antonarakis are Assistant Professors of Oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, in Baltimore, Maryland.Īddress correspondence to: Emmanuel S. Clinical Advances in Hematology & OncologyĬhanning J.

Psa doubling time survival rate