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Evaluating the combined effect of comorbidity and prostate-specific antigen kinetics on the risk of death in men after prostate-specific antigen recurrence
Journal of Clinical Oncology, 11/02/09

Wo JY et al. – Rapid PSA velocity at recurrence is significantly associated with an increased risk of ACM among patients with no or minimal comorbidity but not moderate to severe comorbidity. These findings support judicious use of salvage AST, particularly in men with moderate to severe comorbidities, where prospective surveillance protocols are needed.

Methods

206 men with localized, unfavorable prostate cancer randomly assigned to receive RT alone or RT and AST combined
Cox multivariate regression analysis performed to evaluate relationship between PSA velocity at recurrence and ACM, adjusting for known prostate cancer prognostic factors, including Adult Comorbidity Evaluation 27 comorbidity level

Results

Median follow-up 8.4 years
89 biochemical recurrences and 74 ACM deaths
Higher PSA velocity associated with increased ACM (hazard ratio [HR], 1.47; 95% CI, 1.07 to 1.44; P < .001) after adjusting for age, treatment arm, comorbidity score, and salvage AST
For 89 patients with biochemical recurrence, increasing PSA velocity at recurrence (HR, 1.60; 95% CI, 1.23 to 2.09) and moderate to severe comorbidity score (HR, 7.94; 95% CI, 1.55 to 40.52) were associated with increased ACM
PSA velocity at recurrence associated with significantly higher risk of ACM among patients with no or minimal comorbidity , but not moderate to severe comorbidity

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