HAZARD RATES FOR PROGRESSION AFTER RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE-CANCER

Objectives. We calculated the annual hazard rate (HR) for prostate can cer recurrence after radical prostatectomy (RP) to elucidate the patte rn of treatment failure over time and to assess the efficacy of defini tive therapy. Methods. We calculated the progression-free probabilitie s (PFP) and HRs after RP for a cohort of 611 consecutive men with clin ically localized (cT1-2, NX, MO) prostate cancer and no other treatmen t before documented progression. Results. PFP for the entire study pop ulation was 78% at 5 and 76% at 10 years. The highest HR (0.09) was ob served in the year immediately after surgery and dropped to 0 by year 7 (no patient recurred after year 6). Average annual HRs calculated fo r 3-year intervals resulted in steadily declining HRs over time for th e entire study population and for all subsets, except those with a can cer pathologically confined to the prostate. Overall, the more ominous the prognostic factor, the higher the initial HR. For poorly differen tiated cancers (biopsy Gleason sum 8 to 10), the HR was high in years 1 and 2 and dropped rapidly to 0 thereafter. Conclusions. Prostate-spe cific antigen (PSA) progression after RP usually occurred early (77% w ithin the first 2 years) and was largely due to understaging. Late rec urrences were rare in patients who were regularly evaluated with PSA. However, because the confidence intervals in our study were broad, lar ger patient populations with longer follow-up are needed for a definit ive establishment of the time, course, and pattern of recurrence after surgery. (C) 1997, Elsevier Science Inc. All rights reserved.