1. Postsurgical Risk Factors for Prostate Cancer Mortality Slideset on: Freedland SJ, Humphreys EB, Mangold LA, et al. Risk of prostate cancer–specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005;294:433-439.

2. clinicaloptions.com/onco Oncology Journal Options Freedland S, et al. JAMA. 2005;294:433-439. Background and Rationale  Biochemical relapse (prostate-specific antigen [PSA]  0.2 ng/mL) after radical prostatectomy may presage future metastasis  Improved risk-assessment models needed for refining patient management  Previous cohort analysis evaluated risk of metastasis after rising PSA (n = 304) –Median time from biochemical recurrence to metastasis: 8 years –Median time from metastasis to death: 5 years

3. clinicaloptions.com/onco Oncology Journal Options Freedland S, et al. JAMA. 2005;294:433-439. Baseline Characteristics CharacteristicEligible Patients, n (%) Race  White  Black  Other 360 (95) 14 (4) 5 (1) Gleason score  2-6  7  8-10 54 (14) 195 (51) 130 (34) Extraprostatic spread  Surgical margins  Extracapsular confines  Seminal vesicle  Lymph nodes 178 (47) 337 (89) 143 (38) 124 (33) Postrecurrence PSA doubling time  < 3 mos  ≥ 3 mos 23 (6) 356 (94)

4. clinicaloptions.com/onco Oncology Journal Options Freedland S, et al. JAMA. 2005;294:433-439. Main Findings  Mean time from surgery to biochemical recurrence: 3.5 years  Overall prostate cancer–specific survival from time of biochemical recurrence –5 year: 93% (95% confidence interval [CI]: 90%-96%) –10 year: 73% (95% CI: 66%-79%) –15 year: 55% (95% CI: 41%-67%)

5. clinicaloptions.com/onco Oncology Journal Options Freedland S, et al. JAMA. 2005;294:433-439. Main Findings (cont’d)  High-risk indicators for prostate cancer–specific mortality –Short PSA doubling time (< 3 months) –Gleason score of 8-10 –Time from surgery to biochemical recurrence ≤ 3 years Risk FactorsHazard Ratio (95% CI)P Value PSA doubling time (< 3 mos vs  15 mos) 27.5 (10.7-70.9)<.001 Years from surgery to relapse (  3 vs > 3) 3.5 (1.6-7.8).002 Gleason score (≥ 8 vs < 8)2.3 (1.4-3.8).002

6. clinicaloptions.com/onco Oncology Journal Options Freedland S, et al. JAMA. 2005;294:433-439. Key Conclusions  Select clinical variables helpful in establishing prostate cancer – specific mortality risk in patients with biochemical recurrence after radical prostatectomy –PSA doubling time –Gleason score –Time from surgery to biochemical recurrence  High-risk patients may consequently be identified for early, more aggressive treatment options