The Natural History Of Progression To Psa Recurrence And Metastasis Among At Risk Men Following Radical Prostatectomy.

5036 Background: Active surveillance for low risk disease has been gaining acceptance with the aim of preferentially treating men with NCCN intermediate and high risk prostate cancer. Currently used outcome estimates however, were developed using cohorts, which included a high proportion of men with low or very low- risk disease. Here we describe the natural history of intermediate and high-risk prostate cancer treated only by radical prostatectomy (RP). Methods: Men who underwent RP in the PSA era, initially had undetectable PSAs after surgery, and received no post-RP therapy prior to metastasis were included (1,739 men). Biochemical recurrence (BCR) was defined by a PSA of ≥0.2 ng/ml and metastasis was diagnosed by axial imaging or bone scan. Results: Median follow up was 10 years and 17% developed BCR with a median time to BCR of 3 years (range 1-18). Of men with BCR, 41% developed metastasis (median time 3 years (range 0-11) after BCR). Median time from metastasis to death was 4 years (range 0-11). Me...