PROSTATE-SPECIFIC ANTIGEN DOUBLING TIMES IN PATIENTS WHO HAVE FAILED RADICAL PROSTATECTOMY - CORRELATION WITH HISTOLOGIC CHARACTERISTICS OFTHE PRIMARY-CANCER

Objectives. This study sought to characterize the postoperative prosta te-specific antigen (PSA) doubling time and time to biochemical recurr ence in patients who have failed radical prostatectomy. Methods, Of 53 9 consecutive patients who underwent radical prostatectomy between 198 4 and 1992, postoperative PSA levels in 80 initially became undetectab le (less than 0.07 ng/mL) before eventually increasing, as evidenced b y rising PSA levels above the residual cancer detection limit of the T osoh AIA-600 immunoassay run in the ultrasensitive mode (ie, 0.07 ng/m L or higher). The PSA doubling time and time to biochemical recurrence were calculated for each of the 80 patients and were correlated with the histopathologic variables from the operative specimen. Results, Po stoperative PSA doubling times were predicted by the extent of capsula r penetration, percent Gleason grade 4 or 5, lymph node involvement, a nd tumor volume on univariate analysis and by capsular penetration, pe rcent Gleason grade 4 or 5, lymph node involvement, and patient age on multivariate analysis. Times to recurrence were predicted by the pres ence of positive margins and percent Gleason grade 4 or 5 in both univ ariate and multivariate regression models, The PSA doubling time did n ot correlate with recurrence time. The median PSA doubling time for al l patients was 284 days, and the median time to recurrence was 648 day s. Conclusions. These results demonstrate that PSA doubling time and r ecurrence time are indicative of different biologic characteristics of recurrent prostate cancer: Doubling time appears to represent the agg ressiveness of the original prostate cancer, whereas time to recurrenc e reflects the extent of residual postoperative disease. This informat ion should aid in the selection of men who need greater vigilance duri ng postoperative surveillance. (C) 1997, Elsevier Science Inc.