LOS ANGELES —Men with biochemical recurrence after radical prostatectomy don’t always receive enough information on competing risks of mortality to inform prognosis and guide treatment, according to a new study.

Cedars-Sinai Medical Center-led researchers sought to quantify the risk of prostate cancer metastasis and mortality and other-cause mortality across key clinical predictors. VAMCs in Durham, NC, West Los Angeles and Augusta, GA, also participated in the study.

A report in the Journal of Urology discussed how the team analyzed 1,225 men with BCR after RP from 2001-2017 in the VA SEARCH database.1

Results indicated that, over a median follow-up of 5.6 years after BCR (IQR 2.7,9.1), 243 (20%) men died of other causes and 68 (6%) died of prostate cancer. Researchers explained that multivariable competing risks regression showed that high D’Amico tumor risk and PSA doubling time  at BCR<9 months were associated with metastasis and PCSM (p≤0.001); 10-year PCSM was 14% and 9% for those with high-risk tumors and PSADT <9 mos, respectively.

Other-cause mortality was associated with advanced age and worse comorbidity, with  10-year OCM higher among men 70 or older with any Charlson comorbidity (1-3+) (40-49%) compared with those with none (20%). Optimal variable cutpoints for prediction of PCSM and OCM, with 10-year PCSM ranged from 3-59% and 10-year OCM ranged from 17-50% across risk subgroups.

Among men with BCR after RP, there is significant heterogeneity in prognosis that can be explained by available clinical variables,” the authors wrote. “Men in their 70s with any major comorbidity are 2-10 times more likely to die of other causes than prostate cancer.”

  1. Daskivich TJ, Howard LE, Amling CL, et al. Competing Risks of Mortality Among Men with Biochemical Recurrence after Radical Prostatectomy [published online ahead of print, 2020 Apr 3]. J Urol. 2020;101097JU0000000000001036. doi:10.1097/JU.0000000000001036