title: Identifying men diagnosed with clinically localized prostate cancer who are at high risk for death from prostate cancer.
abstract: OBJECTIVE
  We identified factors at diagnosis that are significantly associated with time to prostate cancer specific mortality following radical prostatectomy or external beam radiation therapy.
  
  
  METHODS
  The study cohort included 1,453 men treated with radical prostatectomy (1,095) or external beam radiation therapy (358) for localized prostate cancer between 1989 and 2002. Cox regression multivariate analysis was used to evaluate whether prostate specific antigen, prostate specific antigen velocity, biopsy Gleason score and clinical tumor category at diagnosis were significantly associated with time to prostate cancer specific mortality following radical prostatectomy or external beam radiation therapy.
  
  
  RESULTS
  In addition to increasing prostate specific antigen (p < or =0.04) and biopsy Gleason score 8 to 10 disease (p < or =0.02), prostate specific antigen velocity more than 2 ng/ml yearly was significantly associated with shorter time to prostate cancer specific mortality in patients treated with radical prostatectomy (adjusted HR 12, 95% CI 3 to 54) and external beam radiation therapy (adjusted HR 12, 95% CI 3 to 54) compared with that in men with prostate specific antigen velocity 2 ng/ml yearly or less (p < or =0.001). Despite low risk disease 7-year estimates of prostate cancer specific mortality were 5% to 19% in patients in whom prostate specific antigen increased by more than 2 ng/ml during the year before diagnosis compared with less than 1% in those with a prostate specific antigen increase of 2 ng/ml or less.
  
  
  CONCLUSIONS
  Despite prostate specific antigen level less than 10 ng/ml and Gleason score 6 cancer a prostate specific antigen increase of more than 2 ng/ml during the year before diagnosis places a man at high risk for prostate cancer death following radical prostatectomy or external beam radiation therapy.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, 75 Francis Street, Boston, MA 02215, USA. adamico@lroc.harvard.edu
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Ming
authors.initials: M
authors.lastname: Hui-Chen
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: Brenda
authors.initials: B
authors.lastname: Sussman
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.forename: William J
authors.initials: WJ
authors.lastname: Catalona
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen