Presented by: Eliana A. Haddadin
University Of California, Irvine

Introduction

Prostate cancer (PC) biochemical recurrence (BCR) is best described as being in slow motion as most men will die with PC rather than of PC. Most BCRs don’t result in PC mortality suggesting an opportunity for observation and either obviating or delaying radiation and/or androgen deprivation (RT/ADT) intervention.  

In 2022 we published that 1/3 of men with BCRs are either benign (non PC-mortal) or have minimal PC mortality potential. We showed that ADT/RT initiation was best based on PSA doubling time (DT) kinetics over surgical pathology. In the present study we look at men who did not undergo castrating ADT/RT with 9-21 year progression outcomes.

Materials

287/1400 (20.5%) men undergoing RARP between 2002-2014 had BCR. Men with early rapid progression underwent ADT/RT and are not included (n=182). PSA observation began 8 weeks post-op. PSA levels were entered into a spreadsheet that calculated DT and DT patterns. Men with non-detectable PSAs or slowly rising PSAs were managed expectantly (AO, n=105).

Results

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Figure 1 presents the overall outcomes since surgery (avg - 14.6 yrs). Of the 105 AO, 86 (82%) were “success” (avg. 11.1 yrs no ADT/RT). AO success had 61 men with increasing DTs (70.9% avg 10.8 yrs) managed without ADT/RT (Fig 2). AO decreasing  (n= 25, 29.1%) typically had prolonged periods of DTs slowly decreasing (Fig 3). 18 (17.1%) died of other causes (avg 9.3 yrs). Of the 105 AO, 19 experienced failure (avg. 8.24 yrs ADT/RT 18%) and to date just 1 death of which was due to PC.

Conclusion

In men 9-21 years post-RP, 36.6% of men with BCR were managed with AO in order to avoid ADT/RT. To date we have been able to avoid ADT/RT in 86 of 287 BCRs (30%). Also, 86 of 105 (82%) have safely avoided ADT/RT and just 1 of 105 AO candidates (0.9%) died of PC. DT pattern has been key.

Funding

None

Lead Authors

Thomas Ahlering, MD
University of California, Irvine

Joshua Tran, MS
University Of California, Irvine

Nick Hassas, BS
University Of California, Irvine

Co-Authors

Rafael Gevorkyan, MS
University Of California, Irvine

Erica Huang, MS
University of Massachusetts Medical School

Catherine Fung, ASNP-BC
University Of California, Irvine