Risk factors for short-term prostate-specific antigen recurrence among patients with nonmetastatic unfavorable-risk prostate cancer

A shorter time interval to prostate-specific antigen (PSA) failure (PSA nadir plus 2 ng/ml or initiation of salvage therapy) is associated with worse clinical outcomes among patients with prostate cancer. Specific factors defining this state remain unknown. Secondary analysis of a phase 3 clinical trial with 350 patients with nonmetastatic unfavorable-risk prostate cancer found that significant factors associated with a shorter time to PSA failure were age younger than 70 years, a PSA level of 10 ng/ml or more, and a Gleason score of 8 to 10. A high-risk group, defined by these 3 factors, had 43.8% risk of PSA failure at 3 years. The authors conclude that patients with unfavorable-risk prostate cancer who are at very high risk for early PSA failure can be identified and may benefit from treatment escalation.