The simplest solution.

Top Line: Not all post-prostatectomy biochemical recurrences are created equal.
The Study: Based on a growing understanding of the multiple indicators of biochemical recurrence badness, the European Association of Urology proposed a “novel” risk stratification model for patients with rising PSA after prostatectomy alone. If you’re looking for something sophisticated, look elsewhere. If you’re looking for something effective, keep reading. They define “high-risk” biochemical recurrence as simply a PSA doubling time ≤1 year or a Gleason Score of 8–10 while “low-risk” is both a doubling time >1 year and a Gleason score ≤7. To validate this ingenious risk stratification, they used it to retrospectively classify 1500 men with a PSA rise of at least 0.2 ng/ml on two consecutive measures following prostatectomy. As expected, at a median follow-up of over 5 years, the metastasis-free survival rate was significantly higher among those with low-risk recurrences (87 → 98%), as was prostate cancer-specific survival (94 → 100%). This binary risk stratification remained a significant predictor on multivariate analysis, as did the receipt of salvage radiation when administered either with PSA below or at/above 0.5 ng/ml.
Bottom Line: While the authors recognize this risk stratification for biochemical recurrence could be refined, they astutely point out that when it comes to clinical utility the simplest solution is often the best solution. | Tilki, Eur Urol 2019


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