A biochemical recurrence refers to an increase in prostate-specific antigen (PSA) after prostate cancer treatment. In a recent study of U.S. veterans, biochemical recurrence was linked with an increased risk of death from prostate cancer. Nevertheless, a majority of men in this population who had a biochemical recurrence did not die of prostate cancer. These findings were recently published in the journal Archives of Internal Medicine.
When prostate cancer has been detected or has returned following initial treatment with surgery, radiation therapy, and/or hormonal therapy, it is said to be recurrent or relapsed. The course of treatment for relapsed prostate cancer depends on what treatment a patient has previously received and the extent of the cancer. Some patients have only a rise in PSA level as evidence of recurrent cancer which is known as biochemical failure or biochemical recurrence (BCR). Other patients will have evidence of recurrent cancer on x-rays or scans. Patients who have prostate cancer that continues to grow despite hormone therapy are referred to as having hormone-refractory prostate cancer.
In a recent study, researchers evaluated prostate cancer patients whose initial recurrence of their disease was a biochemical recurrence in order to determine how many of those patients experienced further disease progression and ultimately died from prostate cancer versus other causes. The researchers observed 623 United States veterans who had been diagnosed with prostate cancer between 1991 and 1995 and were treated with either surgery or radiation; patients were followed until 2006. This population had a high rate of other health problems in addition to prostate cancer.
Depending on initial treatment and duration of follow-up, biochemical recurrence occurred in 34-48% of patients (see Table). Of those patients who experienced a biochemical recurrence following initial treatment with surgery or radiation, 3-42% died of prostate cancer, depending on follow-up period and initial treatment.
Table: 5-, 10- and 15-year rates of biochemical recurrence (BCR) and prostate cancer death after initial treatment with surgery or radiation therapy.
The researchers conclude “Biochemical recurrence is associated with increased prostate cancer mortality, yet when BCR occurs only a minority of men subsequently die of their disease. The phrase ‘most men die with prostate cancer, not of it’ applies to elderly veterans, even after failure of primary treatment.”