What are the 10, 20, and 30 year probabilities of biochemical recurrence, metastasis, and disease-specific death for prostate cancer in a patient with a Prostate-Specific Antigen (PSA) level of 1.8 ng/mL one year prior to radical prostatectomy and 4.0 ng/mL immediately before prostatectomy?

From the Guidelines

I strongly advise against attempting to calculate the 10,20, and 30-year probabilities of biochemical recurrence, metastasis, and disease-specific death for prostate cancer based solely on the provided PSA values, as this would be inaccurate and potentially misleading. The PSA values of 1.8 one year before radical prostatectomy and 4.0 immediately before surgery are insufficient for determining these probabilities, as they do not take into account critical factors such as Gleason score, pathological stage, surgical margin status, lymph node involvement, and other clinical parameters 1. The observed PSA doubling time from 1.8 to 4.0 in one year may suggest relatively rapid PSA kinetics, which could be concerning, but this alone is not enough for accurate risk stratification 1. For meaningful prognostic information, validated risk assessment tools like the CAPRA-S score, Stephenson nomogram, or Memorial Sloan Kettering Cancer Center nomograms should be used, which incorporate comprehensive pathological data 1. These tools can provide more accurate predictions of biochemical recurrence, metastasis, and disease-specific death, and can help guide treatment decisions and follow-up care. Some key points to consider when using these tools include:

• The importance of Gleason score, pathological stage, and surgical margin status in determining the risk of biochemical recurrence and disease-specific death 1
• The role of PSA doubling time in predicting the risk of metastasis and disease-specific death 1
• The need for regular PSA monitoring after surgery, typically starting 6-8 weeks post-prostatectomy and continuing at regular intervals based on the patient's risk profile 1 I recommend consulting with a urologic oncologist who has access to the complete pathology report and can provide personalized risk assessment using these validated tools. Regular follow-up care and monitoring will be essential in managing the patient's prostate cancer and reducing the risk of biochemical recurrence, metastasis, and disease-specific death. Some potential follow-up strategies include:
• Regular PSA testing to monitor for biochemical recurrence
• Imaging studies, such as MRI or PET scans, to detect metastasis or local recurrence
• Consideration of adjuvant or salvage therapies, such as radiation or hormone therapy, in the event of biochemical recurrence or metastasis.

From the Research

Biochemical Recurrence Probability

• The provided studies do not directly calculate the 10,20, and 30 year probability of biochemical recurrence, metastasis, and disease specific death for prostate cancer based on the given PSA data 2, 3, 4.
• However, study 3 suggests that a PSA level of 0.1 ng/mL after radical prostatectomy can be used to define biochemical recurrence, and that early administration of salvage radiation therapy (SRT) at post-RP PSA level <0.2 ng/mL might improve freedom from progression.
• Study 4 reports that the 7-year actuarial prostate-specific antigen (PSA) relapse-free survival was 37%, and that independent predictors of biochemical recurrence were vascular invasion, negative surgical margins, presalvage PSA level >0.4 ng/mL, androgen-deprivation therapy, Gleason score ≥7, and seminal vesicle involvement.

Metastasis and Disease Specific Death Probability

• Study 4 reports that the 7-year actuarial distant metastases-free survival was 77%, and that a doubling time <3 months was the only independent predictor of metastatic disease.
• The provided studies do not provide a direct calculation of the 10,20, and 30 year probability of metastasis and disease specific death for prostate cancer based on the given PSA data 2, 3, 4, 5, 6.

Calculation of Probabilities

• Study 5 discusses the use of Bayes rule to refine diagnostic probabilities, and study 6 illustrates the advantages of the Bayesian approach in quantifying and reporting scientific evidence, but these studies do not provide a direct calculation of the desired probabilities.
• The calculation of the 10,20, and 30 year probability of biochemical recurrence, metastasis, and disease specific death for prostate cancer based on the given PSA data would require additional information and statistical analysis, which is not provided in the given studies 2, 3, 4, 5, 6.