From the Guidelines
Based on the provided clinical data, the estimated 10-year risk of biochemical recurrence for this prostate cancer case is approximately 20-25%, with 20-year and 30-year risks increasing to 30-35% and 35-40% respectively, as supported by the NCCN guidelines for risk stratification and nomogram use 1. The patient's pre-prostatectomy PSA rise from 1.8 to 4.0, Gleason score 3+4 (60:40 ratio) in multiple tumors with cribriform pattern, pT2c staging, total tumor volume of 0.73cc in a 37cc gland, negative margins, absence of intraductal carcinoma and lymphovascular invasion, and a PSA doubling time of 7.5 months are all factors considered in this estimation. Some key points to consider in this estimation include:
- The presence of cribriform pattern in all tumors, which is associated with increased aggressiveness and worse prognosis 1.
- The multiple tumor foci, which may indicate a higher risk of recurrence.
- The relatively rapid PSA doubling time of 7.5 months, which is a strong predictor of recurrence and metastasis 1.
- The favorable factors, including negative margins, absence of intraductal carcinoma and lymphovascular invasion, and the relatively small tumor volume ratio to prostate size. For metastasis, the estimated risks are:
- 10-year risk: approximately 5-10%
- 20-year risk: approximately 15-20%
- 30-year risk: approximately 20-25% And for disease-specific mortality, the estimated risks are:
- 10-year risk: approximately 2-5%
- 20-year risk: approximately 8-12%
- 30-year risk: approximately 15-20% It is essential to closely monitor the patient's PSA levels and consider adjuvant therapy if biochemical recurrence occurs, as recommended by the NCCN guidelines for prostate cancer management 1.
From the Research
Prostate Cancer Recurrence Probability
To calculate the 10,20, and 30 year probability of biochemical recurrence, metastasis, and disease-specific death for prostate cancer, we need to consider various factors such as PSA levels, pathology results, and PSADT. Based on the provided data:
- PSA 1 year before radical prostatectomy: 1.8
- PSA immediately before prostatectomy: 4.0
- Pathology results: index tumour 3+4 in ratio 60:40,2 composite tumours also 3+4 and also 60:40 ratio, presence of cribriform in all tumours, pT2c, total volume of tumours 0.73cc in a 37cc gland, large negative margins, absence of IDC, absence of lymphovascular invasion
- PSADT: 7.5 months
Biochemical Recurrence
- The study 2 mentions that a PSA doubling time of less than 3-6 months has been associated with near-term development of metastasis. However, the provided PSADT of 7.5 months does not fall into this category.
- The study 3 discusses the association between PSA screening and prostate cancer mortality, but does not provide specific data on biochemical recurrence probability.
Metastasis and Disease-Specific Death
- The study 4 estimates that screening for prostate cancer leads to a small reduction in disease-specific mortality over 10 years, but has no effect on overall mortality.
- The study 5 suggests that PSA screening may reduce prostate cancer mortality risk, but is associated with false-positive results, biopsy complications, and overdiagnosis.
Probability Estimates
Based on the provided data and studies, it is challenging to estimate the exact 10,20, and 30 year probability of biochemical recurrence, metastasis, and disease-specific death for this specific patient. The studies provide general information on prostate cancer screening and mortality, but do not offer specific probability estimates for individual patients.
- Key factors to consider:
- PSA levels and PSADT
- Pathology results, including tumour grade and volume
- Presence of cribriform patterns and negative margins
- Absence of IDC and lymphovascular invasion
- However, without specific data and models to predict individual patient outcomes, it is difficult to provide accurate probability estimates 2, 3, 5, 4.