title: Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death.
abstract: BACKGROUND
  This report evaluated whether biochemical recurrence (BCR) as a time-dependent covariate (t) after radical prostatectomy (RP) for prostate cancer was associated with the risk of death and whether salvage therapy with radiotherapy (RT) and/or hormonal therapy (HT) can lessen this risk
  
  
  METHODS
  This was a retrospective cohort study of 3071 men who underwent RP at Duke University between 1988 and 2008 and had complete follow-up data. A Cox regression multivariable analysis was used to determine whether BCR (t) was associated with the risk of death in men after adjusting for age, prostatectomy findings, and the use of salvage RT and/or HT.
  
  
  RESULTS
  After a median follow-up of 7.4 years, 546 (17.8%) men experienced BCR and 454 (14.8%) died. The median follow-up after prostate-specific antigen (PSA) failure was 11.2 years (interquartile range, 5.8-16.0 years). BCR (t) was associated with an increased risk of death (adjusted hazards ratio [AHR], 1.03; 95% confidence interval [95% CI], 1.004-1.06 [P = .025]). In men who experienced BCR, a PSA doubling time <6 months was associated with an increased risk of death (AHR, 1.55; 95% CI, 1.15-2.1 [P = .004]); whereas a decrease in the risk of death was observed in men who received RT (AHR, 0.58; 95% CI, 0.40-0.58 [P = .002]) or HT (AHR, 0.56; 95% CI, 0.37-0.84 [P = .005]) after BCR.
  
  
  CONCLUSIONS
  The occurrence of BCR was found to increase the risk of death in men undergoing RP for prostate cancer, and this risk appeared to increase as the time to BCR shortened. However, the addition of RT and/or HT in men with BCR significantly lowered this risk.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. toni_choueiri@dfci.harvard.edu
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Julia H
authors.initials: JH
authors.lastname: Hayes
authors.forename: Cary N
authors.initials: CN
authors.lastname: Robertson
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Walther
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012306:Risk; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen