Scientific Session 23 — Genitourinary - Renal and ProstateThursday, May 4, 2017
2951. Imaging Differences Between Early and Late Failure in Prostate Cancer Patients After Prostatectomy
Oliveira I*, McDermott S, Kilcoyne A, Harisinghani M. Massachusetts General Hospital, Boston, MA
Address correspondence to I. Oliveira (email@example.com)
Objective: The purpose of our study was to study recurrence of prostate cancer in patients who underwent biochemical failure after radical prostatectomy, correlating time for prostate-specific antigen (PSA) relapse after surgery with imaging findings.
Materials and Methods: Radical prostatectomy was performed on 1672 patients at our institution between January 2000 and December 2004. Of these, 282 had documented PSA failure (PSA level = 0.2 ng/mL at least 1 month after surgery). For all patients with evidence of biochemical recurrence, we reviewed their imaging (bone scan, abdominal CT, or prostate MRI) and identified the recurrence site. We defined the prostatectomy bed and local lymph node involvement as local recurrence. Disease there is potentially curable and necessitates different treatment than distant metastases (bone and other distant sites). For all patients we recorded date and level of PSA recurrence, separating them on two groups: early recurrence (= 1 year after surgery) and late recurrence (> 1 year after surgery). We compared both groups using the Fisher exact test.
Results: Of the 282 patients, 72 (25.5%) had imaging evidence of recurrence. Four patients were excluded from analysis and received adjuvant therapy (external radiation or hormone) after surgery before their PSA level reached the accepted recurrence level. Of 68 patients, 35 (51.5%) had a PSA failure within the first year following surgery and 33 (48.5%) more than 1 year after surgery. Mean PSA level detected at recurrence was 1.43 ng/mL in the early group and 1.91 ng/mL in the late recurrence group. Forty (58.8%) patients had imaging evidence of local recurrence and 28 (41.2%) had imaging evidence of metastatic disease. Seventeen (42.5%) patients with imaging evidence of local recurrence had an early PSA failure and 23 (57.5%) patients had PSA failure more than 1 year after surgery. From 28 metastases, 18 (64.3%) were diagnosed in patients with an early PSA failure and 10 (35.7%) in patients with late failure, which is statistically different (p = 0.006).
Conclusion: Early PSA failure is more associated with metastatic disease on imaging examinations than late PSA recurrence after radical prostatectomy.