Biochemical recurrence after radical prostatectomy – a large, comprehensive, population-based study with long follow-up

Abstract

Objective

We evaluated long-term risk for biochemical recurrence and subsequent prognosis in a population-based cohort.

Material and Methods

We used register-based data to evaluate 6 675 consecutive patients having radical prostatectomy in Västra Götaland county in Sweden during 1995–2014. Patients were followed until death or end of study, 31 December 2014. Data were collected from registers on national, regional and local level and linked by means of the Swedish personal identity number. Biochemical recurrence was defined as PSA ≥0.2 ng/ml; failure as hormonal treatment, metastasis or prostate cancer death. Survival analysis was used to estimate time to biochemical recurrence and time to failure after biochemical recurrence for patients with 0 − 2 years, 2–5 years, 5–10 years and >10 years interval to biochemical recurrence, respectively.

Results

A total of 1214 men had biochemical recurrence during follow-up. Biochemical recurrence-free survival was 83% (95% confidence interval [CI] 82–84%), 75% (95% CI 74–77%) and 69% (95% CI 67–71%) at 5, 10 and 15 years, respectively. Cumulative incidence of failure for all patients 15 years after biochemical recurrence was 50% (95% CI 43–55%) in competing risk analysis. The risk of failure after biochemical recurrence was highest among patients having biochemical recurrence within 2 years from surgery. Incomplete data on PSA-history is a limitation.

Conclusions

The risk for biochemical recurrence persists 15 years after surgery. Follow-up should continue as long as treatment would be considered in case of recurrent disease.

Keywords:

• Recurrence
• prognosis
• prostatectomy
• prostatic neoplasms

Acknowledgement

The authors thank Associate Professor Andreas Josefsson for his efforts to initialize the WSOP database.

Disclosure statement

Johan Stranne has received lecture fees from IPSEN, Astellas, Bayer, Jansen and Ferring and worked as surgical proctor for Intuitive Surgery. Rebecka Arnsrud Godtman has received lecture fees from IPSEN and Astellas.

Additional information

Funding

The WSOP database was supported by grants from Region Västra Götaland, Sahlgrenska University Hospital (ALFGBG grant 75480; agreement concerning research and education of doctors). Part of Elin Axén’s work on this paper was supported by grants from Region Västra Götaland, Sahlgrenska University Hospital (ALFGBG grant 720421; agreement concerning research and education of doctors). The funders had no role in any part of the study design or the conduct of the study, including collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.