Freedom From A Detectable Ultrasensitive Prostate-Specific Antigen At Two Years After Radical Prostatectomy Predicts A Favorable Clinical Outcome

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 01 Dec 2009 - 3:00 PST

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UroToday.com - In the online edition of Urology, Dr. Steven Chang and associates from the SEARCH database report that time to first detectable ultrasensitive PSA (uPSA) identifies men with low-risk recurrence prostate cancer (CaP).

PSA doubling time (PSADT) <9 months in post-radical prostatectomy patients is associated with increased CaP specific mortality. While the standard definition of post-RP recurrence is a PSA >0.2ng/ml, this study determined whether measurement of changes in uPSA over time can identify men who will develop high-risk recurrent CaP as defined by a PSADT <9 months. The study cohort included men in the SEARCH VA database with at least 2 PSA values <0.2ng/ml separated by 3 or more months before biochemical failure and 2 PSA values >0.2ng/ml separated by 3 or more months within 2 years of biochemical failure. Men were stratified into a low-risk group with a PSADT of >9 months and a high-risk group with a PSADT <9 months. The time from surgery to first detectable uPSA and time from detectable uPSA to biochemical failure were determined. uPSA velocity and uPSA doubling time were determined.

A total of 115 men met study inclusion criteria; 89 men in the low-risk group and 26 men in the high-risk group. There were no statistically significant demographic, clinical or pathologic differences between the two groups. In multi-variant analysis, the only independent predictor of PSADT was time to first detectable uPSA. Every month without a detectable uPSA decreased a man's odds of developing a high-risk recurrence by 4%. By 2.5 years post-radical prostatectomy, men without a detectable uPSA did not subsequently develop a high-risk recurrence. uPSA velocity, uPSA doubling time, uPSA exponential rise, and uPSA fluctuation did not predict high-or low-risk recurrence.

Chang SL, Freedland SJ, Terris MK, Aronson WJ, Kane CJ, Amling CL, Presti JC Jr

Urology. 2009 Oct 10. Epub ahead of print.
doi:10.1016/j.urology.2009.06.089

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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