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Biology of Human Tumors

Overdetection of Recurrence after Radical Prostatectomy: Estimates Based on Patient and Tumor Characteristics

Jing Xia, Bruce J. Trock, Roman Gulati, Leslie Mallinger, Matthew R. Cooperberg, Peter R. Carroll, H. Ballentine Carter and Ruth Etzioni
Jing Xia
1Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Bruce J. Trock
2James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Roman Gulati
1Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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  • For correspondence: retzioni@fhcrc.org
Leslie Mallinger
1Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Matthew R. Cooperberg
3Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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Peter R. Carroll
3Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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H. Ballentine Carter
2James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ruth Etzioni
1Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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DOI: 10.1158/1078-0432.CCR-13-3366 Published October 2014
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Abstract

Purpose: Prostate-specific antigen recurrence (PSA-R) after radical prostatectomy (RP) can occur years before metastasis. This study estimates the chance that an untreated PSA-R would not progress to clinical metastasis within the patient's lifetime, that is, that recurrence is overdetected.

Experimental Design: Times from PSA-R to metastasis were estimated from patients with RP treated at Johns Hopkins University (Baltimore, MD) who did not receive salvage treatment (n = 441) at PSA-R. Times to other-cause death were based on U.S. life tables adjusted to reflect other-cause survival among RP cases in the Surveillance, Epidemiology, and End Results (SEER) registry. We used competing risks simulation to estimate lower bounds on the chance that other-cause death would precede clinical metastasis for patients with disease characteristics at diagnosis based on the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database (n = 4,455).

Results: Cumulative incidence of PSA-R in CaPSURE was 13.6% at 5 years and 19.9% at 10 years. The risk of other-cause death among patients with RP in SEER was 60% lower than the age-matched U.S. population. At least 9.1% of patients with PSA-R <5 years after RP and at least 15.6% of patients with PSA-R 5 to 10 years after RP were overdetected. At least 31.4% of patients over the age of 70 years at diagnosis, who recurred <10 years of diagnosis, were overdetected.

Conclusions: This analysis indicates that PSA-R after RP may be overdetected, with risk depending on patient age and tumor characteristics. The potential for overdetection of recurrence confirms the need for approaches to determine whether and when to initiate salvage therapies. Clin Cancer Res; 20(20); 5302–10. ©2014 AACR.

This article is featured in Highlights of This Issue, p. 5145

Footnotes

  • Note: Supplementary data for this article are available at Clinical Cancer Research Online (http://clincancerres.aacrjournals.org/).

  • Received December 13, 2013.
  • Revision received June 3, 2014.
  • Accepted June 10, 2014.
  • ©2014 American Association for Cancer Research.
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Clinical Cancer Research: 20 (20)
October 2014
Volume 20, Issue 20
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Overdetection of Recurrence after Radical Prostatectomy: Estimates Based on Patient and Tumor Characteristics
Jing Xia, Bruce J. Trock, Roman Gulati, Leslie Mallinger, Matthew R. Cooperberg, Peter R. Carroll, H. Ballentine Carter and Ruth Etzioni
Clin Cancer Res October 15 2014 (20) (20) 5302-5310; DOI: 10.1158/1078-0432.CCR-13-3366

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Overdetection of Recurrence after Radical Prostatectomy: Estimates Based on Patient and Tumor Characteristics
Jing Xia, Bruce J. Trock, Roman Gulati, Leslie Mallinger, Matthew R. Cooperberg, Peter R. Carroll, H. Ballentine Carter and Ruth Etzioni
Clin Cancer Res October 15 2014 (20) (20) 5302-5310; DOI: 10.1158/1078-0432.CCR-13-3366
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