MP15-09: Survival estimates of men with biochemically recurrent prostate cancer after radical prostatectomy in a national cohort

Kristian Stensland*, Jennifer Burns, Jordan Sparks, Varsha Vedapudi, Christina Chapman, Megan Caram, Chris Shin, Alexander Zaslavsky, Alexander Tsodikov, Ted Skolarus, Ann Arbor, MI

Introduction: Accurately understanding prostate cancer behavior after radical prostatectomy is important to contextualize treatment plans, design clinical trials, and inform decision-making. For instance, prior data describing the natural history of prostate cancer biochemical recurrence (BCR) after surgery may not reflect contemporary practice. For these reasons, we examined the natural history of men with BCR after radical prostatectomy in a contemporary national cohort.

Methods: We identified men with localized prostate cancer undergoing radical prostatectomy within the Veterans Affairs system from 2005-2015 who did not receive radiation or hormonal therapy within 1 year of surgery. We defined BCR as a PSA rise from undetectable to = 0.2 ng/ml in the electronic health data. We estimated overall survival from BCR to all-cause death using Kaplan-Meier methods and prostate cancer specific-survival from BCR to prostate cancer death via cumulative incidence with other-cause mortality as a competing risk.

Results: Of 18,966 men undergoing surgery, 4,939 had BCR at a median 33 months after surgery [95% Confidence Interval (CI) 14-64]. At a median follow-up of 120 months [IQR 87-149], 5- and 10-year overall survival were 88.4% [95% CI 87.3-89.4%] and 71.8% [95% CI 69.9-73.7%]. Prostate cancer-specific survival at 5 and 10 years was 98.1% [95% CI 97.7-98.6%] and 94.8% [95% CI 93.9-95.7%]. When stratified by salvage treatment, 10-year overall survival was highest for patients treated with salvage radiation alone (76.7% [95% CI 74.1-79.4%]) and lowest for patients treated with salvage ADT alone (61.7% [95% CI 54.1-70.4%]). Prostate cancer-specific survival was similarly highest for salvage radiation or no salvage therapy compared to salvage radiation and ADT or salvage ADT alone.

Conclusions: In a large contemporary cohort of men undergoing radical prostatectomy who had biochemical recurrence, 10-year prostate cancer-specific survival from time of recurrence was nearly 95%. While we observed differential survival based on salvage therapy received, better understanding the timing and use of salvage therapies in an era of emerging diagnostic and therapeutic options appears warranted.

Source of Funding: This work is supported by the National Cancer Institute R01CA242559.