title: Predictors of secondary treatment following biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database.
abstract: OBJECTIVE
  To investigate the predictors of secondary treatment for recurrent prostate cancer after radical prostatectomy (RP) among subjects from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.
  
  
  METHODS
  We used Kaplan-Meier curves and Cox proportional hazard models to identify factors associated with time to secondary treatment and type of secondary treatment received among 697 men who developed biochemical recurrence (BCR) after RP.
  
  
  RESULTS
  During a median follow-up of 45 months after BCR, 357 men received salvage treatment. The 1-, 3-, and 5-year risk of receiving any salvage treatment was 29% (95% confidence interval (CI) 26-33%), 48% (95%CI 44-52%), and 53% (95%CI 49-57%), respectively. In multivariate analysis, more recent year of recurrence, centre, shorter disease-free interval, and pathological high-grade disease (Gleason 8-10) predicted increased risk of salvage treatment (all P < 0.01). Predictors of specifically receiving radiotherapy were shorter disease-free interval, centre, and more recent year of BCR (all P < 0.001). Predictors of specifically receiving hormonal therapy were shorter disease-free interval, more recent year of BCR, centre, high Gleason score, and higher tumour stage (all P < 0.05). In a subset analysis of men with available prostate-specific antigen doubling time (PSADT) data, shorter PSADT predicted receipt of any salvage treatment as well as radiation and hormonal therapy separately. CONCLUSIONS; Among men who recur after RP, salvage treatment was associated with disease severity, centre and year of BCR; patient-specific factors (race, body mass index and age) were not predictive of secondary treatment. Although patients are being treated more aggressively in contemporary years, the affect on long-term survival is unknown.
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA. daniel.moreira@duke.edu
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Moreira
authors.forename: Lionel L
authors.initials: LL
authors.lastname: Bañez
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Presti
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000628:therapy*; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D000970:Antineoplastic Agents; D017430:Prostate-Specific Antigen