PREDICTORS OF SURVIVAL AFTER A POSITIVE POSTIRRADIATION PROSTATE BIOPSY

Purpose: Considerable debate persists in the urologic oncology literat ure with regard to the optimum management of patients with a positive post-irradiation prostate biopsy. This analysis characterizes a group of such patients who have had a favorable course without intervention. Methods and Materials: Between 1956 and 1991, 116 patients have had a positive prostate biopsy 12 or more months post-irradiation without h ormonal intervention or evidence of distant relapse. The population ha d an age range of 42 to 82 years (median - 61). American Joint Committ ee on Cancer stages included 1 T1, 70 T2, 44 T3, and 1 T4. Median actu arial survival for the entire population was 14.4 years (range = 2.2-2 1.5 years) from presentation and 5.2 years from re-biopsy. Results: Fi fty-one of the 116 patients developed metastases subsequent to re-biop sy and 65 remain free from distant relapse. Among these 65 patients, 5 0 remain alive and otherwise well, 11 have died of other causes, and o nly four have succumbed to their local disease. The best predictor of distant relapse subsequent to re-biopsy was digital rectal exam. Forty -one of the 51 patients later developing metastases had an abnormal di gital rectal exam compared to 37 of 65 with sustained distant control (p =.01). Conclusion: These data demonstrate that long-term, disease-f ree (other than re-biopsy) survival is common following a ''positive'' post-irradiation biopsy without intervention especially among patient s with a normal digital rectal exam. Therefore, routine rebiopsy witho ut clinical indications is not it useful practice.