Biochemical freedom from recurrence: the facts

Following complete removal of the prostate by radical prostatectomy, the PSA value is normally "zero" as there is no longer any tissue left to produce the prostate-specific antigene (PSA).  If, however, after the operation a PSA value of  over 0.2 ng/ml is detected, it is considered evidence of recurring tumor activity. This is called a biochemical recurrence. A biochemical recurence is not automatically life-threatening. It may mean that futher therapy, such as follow-up radiation or hormone therapy, is necessary. 

Of the patients who underwent radical prostatectomy at the Martini Clinic between 1992 and 1997, and in whom the tumor had not spread outside the prostate gland (a so-called pT2 tumor), more than 87% were free from biochemical recurrence during the 10 years following the operation. The rate of biochemical freedom from recurrence in all the patients treated by doctors at the Martini Clinc  - incuding the men in whom the tumor had already spread outside the prostate - is 65% after 10 years. 

Biochemical freedom from recurrence in our patients after 10 years (in percent)

The tableshown on the site Prognosis shows the rate of biochemical freedom from recurrence in our patients, according to the stage of the tumor.  If the tumor was confined to the organ (green line), 87% of the men were free from recurrence, even after 10 years (120 months). If the tumor had spread outside the prostate (purple line), in more than 53% of our patients no PSA could be detected after 10 years. If the cancer cells had already spread to the seminal vesicle (light-blue line), only 28 ( 6%)  of the patients were free from biochemical recurrence. 

Radiation therapy: The earlier the treatment, the better the cure rate

The PSA value is also the most significant indicator when assessing the likelihood of a cure following radiation therapy, HDR or LDR brachytherapy. However, the significance of the PSA value following radiation therapy differs to that after a radical prostatectomy. A real "zero value", such as found after radical prostatectomy, is not the norm, as the prostate gland, and therefore  the tissue producing PSA, is still within the body. It is therefore more difficult to identify any recurrence than after surgical therapy. The long-term healing process after brachytherapy, however, is similar to that following a radical prostatectomy.  The cure rate of patients treated wth radiotherapeutic methods also depends the stage of the tumor at diagnosis; the earlier the diagnosis, the better the cure rate after brachytherapy.