Three-Year Postoperative Ultrasensitive Prostate-Specific Antigen Following Open Radical Retropubic Prostatectomy Is a Predictor for Delayed Biochemical Recurrence

• Published in: European urology Vol. 60; no. 3; pp. 548 - 553
• Main Authors: Malik, Rena D., Goldberg, Judith D., Hochman, Tsivia, Lepor, Herbert
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.09.2011; Elsevier
• Subjects: Academic Medical Centers; Biochemical recurrence; Biological and medical sciences; Chi-Square Distribution; Disease-Free Survival; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Nephrology. Urinary tract diseases; New York City; Predictive Value of Tests; Proportional Hazards Models; Prostate specific antigen (PSA); Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - immunology; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radical prostatectomy; Retrospective Studies; Risk Assessment; Risk Factors; Salvage Therapy; Sensitivity and Specificity; Survival Rate; Time Factors; Treatment Outcome; Urology; New York City; Radical prostatectomy; Biochemical recurrence; Prostate specific antigen (PSA); Postoperative; Nephrology; Prognosis; Tumoral marker; Delay; Urology; Prostate specific antigen; Treatment; Surgery; Retropubic route; Prostatectomy; Surgical approach; Predictive factor
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2011.05.036

Prostate-specific antigen (PSA) is the only independent predictor of biochemical recurrence (BCR) following radical prostatectomy (RP) subject to change over time. To determine whether an ultrasensitive PSA measured at 3 yr following RP is a predictor of subsequent BCR. There were 1197 consecutive men with clinically localized prostate cancer who underwent an open radical retropubic prostatectomy (ORRP) at a tertiary referral academic medical center. Exclusions included 107 men (8.9%) who developed a PSA level ≥0.2 ng/ml or underwent hormone therapy or radiation therapy (RT) within the first 3 r after surgery, 191 men (16%) who did not undergo a 3-yr ultrasensitive PSA assay, and 98 men (8.2%) who had PSA levels ≥0.1 and <0.2 at 3 yr. The remaining 801 men were stratified into two groups based on their ultrasensitive PSA level at 3 yr postoperatively: group 1, which consisted of patients whose PSA was ≤0.04 (n=765), and group 2, which consisted of patients whose PSA was >0.04 and <0.10 (n=36). Delayed BCR was the primary end point and represented those men in this cohort who developed a PSA level ≥0.2 or underwent salvage RT for a persistently rising PSA level after 3 yr of follow-up. The 7-yr cumulative BCR-free survival rate for groups 1 and 2 was 0.957 (95% confidence interval [CI], 0.920–0.978) and 0.654 (95% CI, 0.318–0.855), respectively. In multivariable Cox proportional hazards models, ultrasensitive PSA level at 3 yr remained the only significant predictor of delayed BCR (likelihood ratio χ2 for full model: 27.03; df=1; p < 0.001). A limitation of the study is that no uniform PSA assay was obtained. Our findings provide compelling evidence that an ultrasensitive PSA at 3 yr following RP provides useful insights into delayed BCR and is a source of reassurance for the overwhelming majority of men being followed for delayed recurrences. An ultrasensitive prostate-specific antigen (PSA) level obtained 3 yr following radical prostatectomy provides useful insights into subsequent delayed biochemical recurrence (BCR). In fact, ultrasensitive PSA levels at 3 yr represent the only significant predictor of delayed BCR.