Third study confirms value of PSADT as a prognostic indicator post-surgery


Earlier studies based on data from Johns Hopkins and the Center for Prostate Disease Research have shown that PSA doubling times are strongly associated with risk for metastasis, prostate cancer-specific, and overall mortality.

A new study by Teeter et al., based on the data from the SEARCH database, has now confirmed these findings in an older, racially diverse cohort of men treated by radical prostatectomy (RP) at a group of Veterans Affairs medical centers.

This newly published study reports on data from 345 men in the SEARCH database who underwent an RP between1988 and 2008. The authors looked specifically at the association between PSADT at initial recurrence and the time from recurrence to overall and prostate cancer-specific mortality using the clinically significant PSADT cutpoints of < 3.0, 3.0 to 8.9, 9.0 to 14.9, and ≥ 15.0 months.

Teeter et al. were able to show that, in this patient cohort, compared to a PSADT of ≥15 months:

  • Men with a PSADT of < 3 months had a poorer overall survival  (hazard ratio [HR] = 5.48, P = 0.002).
  • Men with a PSADT of 3.0 to 8.9 months showed a trend toward poorer overall survival (HR = 1.70, P = 0.07).
  • PSADTs of < 3 months (P < 0.001) and 3.0 to 8.9 months (P = 0.004) were associated with an increased risk of prostate cancer-specific mortality.

PSADT is clearly a valuable prognostic tool for identifying men at increased risk of all-cause and prostate cancer-specific mortality early in their disease course.

3 Responses

  1. Mike,

    A quick question for you on calculating PSADT while on IADT. Before starting my last ADT cycle my PSADT was about 2 months based on a period from nadir < 0.05 (May 2009) to 5.08 (Jan 2010). This time it went from 0.24 (Oct 2010) to 5.6 (Jan 2011). Obviously a very big % increase over a short time frame.

    I asked my doctor if this was all new growth or a function of recovering T effect on dormant tumor cells. He indicated (indirectly) likely a mix of the two but did not really answer the question. In any event I guess it is a moot point, I would think this is a fast doubling time but wonder if it would continue at this rate or slow down over time. Any thoughts. BTW these types of studies are really good news for guys who recur but have longer doubling times.

    Bill

  2. Bill: The meaningfulness of PSADT in men on continuous and intermittent ADT (as opposed to in men who are having a biochemical response after first-line treatment) is not nearly so well established.

    Obviously my general sense would be that — in men on hormone therapy — a shorter PSADT is clearly less good than a long PSADT, and anything under 3 months is a clear signal of aggressive disease. However, the real question for such men is whether the hormone therapy can keep the PSA at or close to 0.00 when it is in use. In other words, what is important in your case (and others like you) is how fast your PSA can be knocked back down to near 0.00 and how long it stays close to the nadir when you come off ADT. By comparison, the PSADT itself may not be so important.

    What we probably need are studies similar to the one above correlating PSADT (over time) with survival data for men on continuous and intermittent ADT. I am not aware of any such data at present. I am also not aware of whether anyone has the tools to tell whether your PSA is going up because of truly new cancer cell growth or re-expression of PSA in hormone-suppressed prostate cancer cells.

  3. There are very few studies I have discovered re. the pattern of PSA resumption after ADT treatment of any form. What has been done is not particularly conclusive. Notwithstanding, let me reference three I found via PubMed whilst researching my own pattern:

    (1) Changes in PSA and hormone levels following withdrawal of prolonged androgen ablation for prostate cancer (Egawa et al., 2003)

    (2) A prospective analysis of time to normalization of serum testosterone after withdrawal of ADT (Nejat et al., 2000)

    (3) Undetectable PSA at 6-12 months for early success in hormonally treated patients after prostate brachytherapy (Miller et al., 2005)

    The research is scarce. I spoke with Chuck Ryan (UCSF) about this last week when accompanying a buddy to his appointment. He mentioned that Anthony D’Amico has done some work but i have not yet tracked it down.

    rd

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