Defining biochemical recurrence of prostate cancer after radical prostatectomy: A proposal for a standardized definition Journal Article


Authors: Stephenson, A. J.; Kattan, M. W.; Eastham, J. A.; Dotan, Z. A.; Bianco, F. J. Jr; Lilja, H.; Scardino, P. T.
Article Title: Defining biochemical recurrence of prostate cancer after radical prostatectomy: A proposal for a standardized definition
Abstract: Purpose: Prostate-specific antigen (PSA) defined biochemical recurrence (BCR) of prostate cancer is widely used for reporting the outcome of radical prostatectomy (RP). A standardized BCR definition is lacking, and overall progression-free probability and risk of subsequent metastatic disease progression may vary greatly depending on the PSA criterion used. Ten definitions of BCR were evaluated to identify the one that best explains metastatic progression. Methods: Of 3,125 patients who underwent RP at our institution since 1985, 75 developed distant metastasis during a median follow-up of 49 months. To predict metastasis progression, we modeled the clinical information using multivariable Cox regression analysis. BCR was included in the model as a time-dependent covariate, and separate models were developed for each definition. A goodness-of-fit (R2) statistic was used to determine the Cox model (and thereby the BCR definition) that best explained metastatic progression. Results: The 10-year progression-free probability ranged from 63% to 79%, depending on the BCR definition. The model containing BCR defined as a PSA of at least 0.4 ng/mL followed by another increase best explained metastatic progression (R2 = 0.21). This definition was also associated with a high probability of subsequent secondary therapy, continued PSA progression, and rapid PSA doubling time. Conclusion: BCR defined as a PSA value of at least 0.4 ng/mL followed by another increase best explains the development of distant metastasis among 10 candidate definitions, after controlling for clinical variables and the use of secondary therapy. On the basis of this evidence, we propose that this definition be adopted as the standard for reporting the outcome of RP. © 2006 by American Society of Clinical Oncology.
Keywords: controlled study; aged; middle aged; major clinical study; disease course; cancer localization; cancer recurrence; cancer growth; follow up; methodology; prostate specific antigen; metastasis; neoplasm recurrence, local; proportional hazards models; pathology; prostate cancer; prostate-specific antigen; prostatic neoplasms; standardization; blood; immunology; medical information; proportional hazards model; probability; prostatectomy; disease progression; tumor recurrence; prostate tumor; multivariate analysis; nomenclature; covariance
Journal Title: Journal of Clinical Oncology
Volume: 24
Issue: 24
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2006-08-20
Start Page: 3973
End Page: 3978
Language: English
DOI: 10.1200/jco.2005.04.0756
PUBMED: 16921049
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 125" - "Export Date: 4 June 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Zohar A Dotan
    19 Dotan
  2. Peter T Scardino
    621 Scardino
  3. Hans Gosta Lilja
    286 Lilja
  4. James Eastham
    426 Eastham
  5. Fernando J Bianco
    72 Bianco