What happens to men diagnosed with metastatic prostate cancer after primary surgery if they have never received hormonal therapy (androgen blockade) by means of drugs like Lupron, Zoladex or Casodex? In a paper e-published October 30 in European Urology, Memorial Sloan Kettering researchers Peter Scardino, Howard I Scher and O. Yossepowitch et al. look at this issue.

The results may be of interest to those men who wonder if they might be putting themselves at risk by not accepting hormonal blockade before or immediately after primary treatment with radical prostatectomy.

The aim was to follow the “natural history of metastatic prostate cancer after radical prostatectomy (RP) in patients followed expectantly for rising prostate-specific antigen (PSA) (noncastrate metastases).”

The MSKCC doctors followed “95 patients who developed clinically detectable noncastrate metastases after RP.” In these patients, the first noticed evidence of metastatic spread varied from “minimal (nodal or axial skeletal involvement) to “extensive (appendicular skeletal involvement or visceral metastases). ”

Median disease-specific survival in these men who were diagnosed with metastases and who took no androgen blockade drugs before this diagnosis was 6.6 yr (with a range in 95% of cases between 5.2 and 7.9 years).

“The initial site of metastatic disease was bone, lymph node, and viscera in 63%, 36%, and 6% of patients, respectively. Thirteen patients (14%) had extensive disease at their first metastatic manifestation.”

Markers for improved survival were “longer PSA doubling time in the rising PSA state,” with an improved survival odds for each month of doubling time; and “the initial metastatic phenotype .” Patients with “minimal” disease on first evidence of recurrence did better than patients with “extensive disease.”

“The prostatectomy Gleason score, lymph node status at RP, PSA level at diagnosis of metastases, and interval from surgery to diagnosis of metastases did not correlate with outcome.”

The researchers conclude: “Men who develop noncastrate metastases after RP may have a durable survival. Favorable prognostic indicators include longer PSA doubling time preceding diagnosis of metastases and initial involvement of axial skeleton or lymph nodes.”

Source: PUBMED abstract of Eur Urol. 2006 Oct 30; [Epub ahead of print]
The Natural History of Noncastrate Metastatic Prostate Cancer after Radical Prostatectomy. Yossepowitch O, Bianco FJ Jr, Eggener SE, Eastham JA, Scher HI, Scardino PT.
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States.