Recurrent PSA after prostatectomy for prostate cancer: implications of PSA doubling time

After radical prostatectomy for prostate cancer, men frequently develop detectable levels of prostate specific antigen (PSA). A slow rate of increase, as characterized by the PSA doubling time (PSADT) is the principal marker for a favorable prognosis. Data and results presented in 2 recent clinical articles studying cohorts of men with clinical stage T1/T2 prostate cancer are reviewed and used to develop mortality analyses. Life-table analysis shows a mortality ratio of 257% at 5 years for Gleason score < 8, PSA recurrence > 2 years after surgery for clinical stage T1/T2 disease, and PSA doubling time (PSADT) > 10 months. Markov modeling using transition probabilities derived from the clinical articles to develop a life table analysis yields a mortality ratio of 145% at 10 years for similar patients.