From the Guidelines
Based on the provided clinical data, I can estimate the following probabilities for biochemical recurrence, metastasis, and disease-specific death for this prostate cancer case, with the most recent and highest quality study guiding my recommendation 1. For a patient with a pre-prostatectomy PSA rise from 1.6 to 4.4, Gleason score 3+4 (Grade Group 2) in multiple tumors with cribriform pattern, pT2c disease (confined to the prostate), negative margins, absence of intraductal carcinoma and lymphovascular invasion, and a PSA doubling time of 7.5 months post-treatment, the approximate risks are as follows.
Estimated Risks
- The 10-year probability of biochemical recurrence is approximately 20-25%, with this risk increasing to 30-35% at 20 years and 35-40% at 30 years.
- For metastasis, the estimated probability is 5-10% at 10 years, 15-20% at 20 years, and 20-25% at 30 years.
- The disease-specific mortality risk is quite low at approximately 1-3% at 10 years, 5-8% at 20 years, and 10-15% at 30 years. These estimates reflect the relatively favorable pathological features (organ-confined disease, negative margins) balanced against adverse factors (cribriform pattern, multiple tumors, and moderately rapid PSA doubling time) as discussed in the context of salvage therapy for prostate cancer 1.
Key Considerations
- Regular PSA monitoring is essential, with measurements recommended every 3-6 months for the first 2 years and then annually thereafter.
- Any PSA rise above 0.2 ng/mL would indicate biochemical recurrence and warrant consideration of salvage therapy options, taking into account the patient's overall health, preferences, and the potential benefits and harms of such treatments 1.
- The decision for salvage therapy should be made with consideration of the patient's risk factors, including PSA doubling time, Gleason score, and pathological stage, as these factors influence the likelihood of disease progression and the potential benefit of salvage radiation therapy 1.
From the Research
Biochemical Recurrence Probability
- The provided studies do not directly address the calculation of 10,20, and 30 year probabilities of biochemical recurrence, metastasis, and disease-specific death for prostate cancer based on the given patient data 2, 3, 4, 5, 6.
- However, study 4 investigates the relationship between PSA doubling time (PSADT) and initial management of prostate cancer with short-term androgen deprivation (STAD) and the impact of these factors on disease progression after radiation therapy.
- The study found that predictors of a longer PSADT were time to biochemical failure (TTBF) >12 months, Gleason Score 2-6, and STAD, which may be relevant for estimating biochemical recurrence probability.
Metastasis and Disease-Specific Death Probability
- Study 2 reports on the long-term update of the NRG/RTOG 9408 randomized clinical trial, which demonstrated that adding short-term androgen deprivation therapy (ADT) to radiation therapy (RT) improved disease-specific mortality (DSM) and freedom from distant metastases (DM) in men with localized prostate cancer.
- Study 6 provides an overview on the use of androgen deprivation therapy (ADT) added to salvage radiation therapy (SRT) for prostate cancer patients with biochemical recurrence after prostatectomy, and found that ADT combined with SRT appears to improve overall survival (OS) in patients with a PSA level before SRT of ≥0.7 ng/mL.
- However, these studies do not provide a direct method for calculating the 10,20, and 30 year probabilities of metastasis and disease-specific death for the given patient data.
Patient-Specific Data
- The patient's data, including PSA levels, pathology results, and PSADT, may be relevant for estimating the probabilities of biochemical recurrence, metastasis, and disease-specific death.
- However, without a direct reference to a study that addresses the calculation of these probabilities based on similar patient data, it is not possible to provide a accurate estimate 2, 3, 4, 5, 6.