Abstract: PD07-09
Sources of Funding: None

Introduction

While our understanding of early and intermediate biochemical recurrence is robust, the time-course and clinical features of delayed biochemical recurrence are less well defined. We examined the clinical features and outcomes associated with delayed biochemical recurrence after radical prostatectomy, specifically amongst men with over 20 years of follow-up.

Methods

16,720 men underwent radical prostatectomy and 2,699 experienced biochemical recurrence. We determined predictors of delayed biochemical recurrence as well as metastasis-free survival and cancer specific survival rates for recurrence at various time points after radical prostatectomy. We performed a subset analysis of the 732 men with 20 or more years of recurrence free follow-up. Actuarial metastasis-free and cancer specific survival was calculated to determine the actuarial probability of biochemical recurrence at 30 years after radical prostatectomy.

Results

The majority of biochemical recurrence occurred within five years of radical prostatectomy, and decreased with each five-year period. Delayed biochemical recurrence was associated with favorable metastasis-free survival and cancer specific survival compared to early biochemical recurrence (Figure). Amongst the 732 men with an undetectable prostate specific antigen at 20 years, 17 (2.3%) developed a biochemical recurrence, a single patient developed metastatic disease, and none died due to prostate cancer. The actuarial probability of biochemical recurrence amongst men with an undetectable prostate specific antigen at 20 years increased with adverse pathologic features.

Conclusions

Men with delayed biochemical recurrence have favorable clinical features and improved survival. Men with an undetectable prostate specific antigen 20 years after radical prostatectomy had a very low rate of recurrence and no deaths due to prostate cancer. This suggests that 20 years is a reasonable time point to discontinue PSA testing. _x000D_ _x000D_ Figure. Kaplan-Meier curves for actuarial (a) metastasis-free survival and (b) cancer-specific survival, stratified by the timing of biochemical recurrence (4 groups)._x000D_

Funding

None