WASHINGTON, DC USA (UroToday.com) - The first detectable ultrasensitive PSA (uPSA) was the strongest predictor of treatment failure after radical prostatectomy (RP) according to this report from UCLA.
Using the standard cutoff for biochemical recurrence (BCR) of > 0.2 ng/ml, approximately 25% of patients with "undetectable" PSA values will experience BCR after 5 years. This study evaluated a cohort of men who underwent RP and correlated their post-operative uPSA trends with clinicopathologic variables and BCR. It was done by a retrospective review to capture men who underwent RP with at least 2 post-RP uPSA values recorded. The initial post-RP uPSA (uPSAINITIAL) was obtained at approximately 3 months and regularly thereafter. Undetectable was defined as <0.01ng/mL and treatment failure as uPSA>0.1ng/mL or salvage radiotherapy (XRT).
In total, 319 men were evaluated over a median follow-up of 51.4 months. Overall, 232 men (72.7%) had an undetectable uPSA-INITIAL, of which 40 (17.2%) eventually went on to fail. Patients with an undetectable uPSA-INITIAL who later failed had significantly worse pathologic characteristics (Gleason sum: 7.2 vs. 6.5, p=<0.0001; perineural invasion: 79.4% vs. 46.7%; tumor size: 2.5cm vs. 1.8cm; pT3: 32.5% vs. 5.7%,), higher median uPSA-first detectable: 0.02 vs. 0.01ng/mL, and a more rapid median time to detectable status: 15.9 mo vs. 24.8 mo. On multivariate analysis, the first detectable uPSA was an independent predictor of treatment failure (HR 1.81, p >0.0001). Other independent predictors included pre-treatment PSA (HR 1.08, p=0.009) and pathological stage (HR 1.5, p = 0.02). Kaplan-Meier plotting of BCR as a function of uPSA demonstrated significant discriminatory power at an uPSAfirst detectable level of 0.03ng/mL. They concluded that an initial postoperative uPSA of >0.03ng/mL was highly predictive of progression to 0.1ng/mL or XRT.
Presented by David S. Finley, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.