Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival

• DOI: 10.1054/bjoc.2000.1474
• Publication Date: 2002-07-26T11:27:09Z
• Authors: A P Doherty; M Bower; G L Smith; R Miano; E M Mannion; H Mitchell; T J Christmas
• Keywords: Adult; Male; ANTIGEN; Predictive Value of Test; Sensitivity and Specificity; Disease-Free Survival; SERUM; Decision Support Techniques; Decision Support Technique; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Humans; PRESERVATION; Oncology & Carcinogenesis; RECURRENCE; COMBINATION; Multivariate Analysi; radical retropubic prostatectomy; Aged; Neoplasm Staging; Proportional Hazards Models; Prostatectomy; Salvage Therapy; RETROPUBIC PROSTATECTOMY; SURGICAL MARGINS; Science & Technology; Settore MED/24 - UROLOGIA; PATHOLOGICAL FINDINGS; Prostatic Neoplasms; Regular Article; Middle Aged; Prostate-Specific Antigen; ONCOLOGY; prostate cancer; PSA nadir; Sensitivity and Specificity; Disease-Free Survival; Neoplasm Staging; Prostatectomy; Humans; Prostate-Specific Antigen; Salvage Therapy; Aged; Predictive Value of Tests; Multivariate Analysis; Adult; Middle Aged; Prostatic Neoplasms; Male; Decision Support Techniques; Proportional Hazards Models; TIME; 3. Good health; Oncology; Prostatic Neoplasm; Multivariate Analysis; RESOLVED IMMUNOFLUOROMETRIC ASSAY; Life Sciences & Biomedicine; 1112 Oncology And Carcinogenesis; Human

Radical retropubic prostatectomy is considered by many centres to be the treatment of choice for men aged less than 70 years with localized prostate cancer. A rise in serum prostate-specific antigen after radical prostatectomy occurs in 10-40% of cases. This study evaluates the usefulness of novel ultrasensitive PSA assays in the early detection of biochemical relapse. 200 patients of mean age 61. 2 years underwent radical retropubic prostatectomy. Levels < or = 0.01 ng ml-1 were considered undetectable. Mean pre-operative prostate-specific antigen was 13.3 ng ml-1. Biochemical relapse was defined as 3 consecutive rises. The 2-year biochemical disease-free survival for the 134 patients with evaluable prostate-specific antigen nadir data was 61.1% (95% CI: 51.6-70.6%). Only 2 patients with an undetectable prostate-specific antigen after radical retropubic prostatectomy biochemically relapsed (3%), compared to 47 relapses out of 61 patients (75%) who did not reach this level. Cox multivariate analysis confirms prostate-specific antigen nadir < or = 0.01 ng ml-1 to be a superb independent variable predicting a favourable biochemical disease-free survival (P < 0.0001). Early diagnosis of biochemical relapse is feasible with sensitive prostate-specific antigen assays. These assays more accurately measure the prostate-specific antigen nadir, which is an excellent predictor of biochemical disease-free survival. Thus, sensitive prostate-specific antigen assays offer accurate prognostic information and expedite decision-making regarding the use of salvage prostate-bed radiotherapy or hormone therapy.