Prostate-specific antigen doubling time is a reliable predictor of imageable metastases in men with biochemical recurrence after radical retropubic prostatectomy.

OBJECTIVES

To examine the incidence of imageable metastases at the time of biochemical recurrence after radical prostatectomy and to determine whether prostate-specific antigen doubling time (PSADT) reliably predicts these imageable metastases.

METHODS

Between October 2000 and October 2005, 1112 men underwent open radical retropubic prostatectomy by a single surgeon. All men were advised to undergo bone scintigraphy and an abdominal/pelvic imaging study at the time of biochemical recurrence. We ascertained the sensitivity, specificity, and positive and negative predictive values of a PSADT cut-point of 3 months to predict the presence of imageable metastases.

RESULTS

Seventy-four (6.7%) men developed a biochemical recurrence and imageable metastases were demonstrable in 7 cases. Imageable metastases were identified in 11.3% and 7.5% of men undergoing bone scans and abdominal/pelvic imaging, respectively. Extracapsular extension, and older age positive surgical margins, and PSADT were associated with a significantly greater risk of exhibiting imageable metastases. The sensitivity, specificity, and positive and negative predictive values of a PSADT cut-point of 3 months for predicting imageable metastasis were 100%, 98.0%, 87.5%, and 100%, respectively.

CONCLUSIONS

A relatively small proportion of men at the time of developing biochemical recurrence after radical prostatectomy exhibit imageable metastasis. The 100% sensitivity and negative predictive value of a PSADT cut-point of 3 months strongly suggests that PSADT can be used as an excellent proxy for imageable metastasis. Omitting routine bone scintigraphy and body imaging at the time of biochemical recurrence minimizes the costs, inconvenience, and anxiety associated with these studies.