January 22, 2016
So you had radical prostatectomy and things have been going pretty well. You feel good, and your PSA remains undetectable. It's been several years now; are you out of the woods?
"After radical prostatectomy, about a third of men experience a return of PSA," says urologist Misop Han, M.D. the David Hall McConnell Professor in Urology. "However, only a very small number of men who have had surgery ultimately die from prostate cancer. So, men contemplating surgery or those who have already had surgery may wonder, What is my chance of surviving from prostate cancer if I have not had PSA recurrence for several years after surgery?"
Han and Brady epidemiologist Bruce Trock, Ph.D., recently set out to answer that question, using the Brady's massive database to track results from more than 14,000 men who had surgery at Johns Hopkins between 1984 and 2013. They divided men into three risk groups: low, intermediate, and high. Then they calculated what they call the Conditional Survival probability — the likelihood of survival for 10 additional years.
They found that men in the low- and intermediate-risk groups had a very high probability — at least 96 percent — of not dying from a return of prostate cancer at 10 years, "regardless of the time duration without recurrence," says Han. "In other words, these men are highly unlikely to die from prostate cancer, regardless of whether they experience recurrence or not." In the high-risk men, the probability of survival from prostate cancer at 10 years was 91 percent for those who experienced recurrence within one year. "However, if these high-risk men do not have recurrence for more than three years, their probability of survival from prostate cancer for 10 additional years is even higher — greater than than 99 percent.
"These results give much hope for men with prostate cancer," said Han. "Overall, men are highly unlikely to die from prostate cancer after surgery — even men with high-risk prostate cancer. If you do not experience recurrence for several years, your likelihood of survival for 10 more years is outstanding."