Overdetection of recurrence after radical prostatectomy: Estimates based on patient and tumor characteristics

Jing Xia, Bruce J. Trock, Roman Gulati, Leslie Mallinger, Matthew R. Cooperberg, Peter R. Carroll, H. Ballentine Carter, Ruth Etzioni

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Purpose: Prostate-specific antigen recurrence (PSA-R) after radical prostatectomy (RP) can occur years before metastasis. This study estimates the chance that an untreated PSA-R would not progress to clinical metastasis within the patient's lifetime, that is, that recurrence is overdetected. Experimental Design: Times from PSA-R to metastasis were estimated from patients with RP treated at Johns Hopkins University (Baltimore, MD)who did not receive salvage treatment (n = 441) at PSA-R. Times to other-cause death were based on U.S. life tables adjusted to reflect other-cause survival among RP cases in the Surveillance, Epidemiology, and End Results (SEER) registry. We used competing risks simulation to estimate lower bounds on the chance that other-cause death would precede clinical metastasis for patients with disease characteristics at diagnosis based on the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database ( n = 4,455). Results: Cumulative incidence of PSA-R in CaPSURE was 13.6% at 5 years and 19.9% at 10 years. The risk of other-cause death among patients with RP in SEER was 60% lower than the age-matched U.S. population. At least 9.1% of patients with PSA-R <5 years after RP and at least 15.6% of patients with PSA-R 5 to 10 years after RP were overdetected. At least 31.4% of patients over the age of 70 years at diagnosis, who recurred <10 years of diagnosis, were overdetected. Conclusions: This analysis indicates that PSA-R after RP may be overdetected, with risk depending on patient age and tumor characteristics. The potential for overdetection of recurrence confirms the need for approaches to determine whether and when to initiate salvage therapies.

Original languageEnglish (US)
Pages (from-to)5302-5310
Number of pages9
JournalClinical Cancer Research
Issue number20
StatePublished - Oct 15 2014
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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