PURPOSE: Prostate-specific antigen (PSA) is an important tool for monitoring of patients with prostate cancer (PCa) after radical prostatectomy (RP).
Ultrasensitive PSA (uPSA) assays with a lower limit of detection (LLD) of as low as 0.001 ng/ml are being increasingly used. This systematic review examines current available uPSA technologies and the role of uPSA in monitoring patients after RP.
MATERIALS AND METHODS: A search of relevant literature was performed using the Medline database. Studies that presented serial uPSA (lower detection limit < 0.1 ng/ml) data of men following RP and had comparative data from standard PSA (lower detection limit ≥0.1 ng/ml) for a variety of study objectives, were eligible for review.
RESULTS: The utilization of uPSA can detect PCa recurrence potentially years earlier when compared with standard PSA assays. The specificity of detectable uPSA is low. uPSA kinetics may improve the positive predictive value in detecting cancer recurrence. However, utility of PSA doubling time at the ultrasensitive level remains controversial. An undetectable nadir uPSA value after RP confers a low risk of disease recurrence. A detectable nadir uPSA above 0.01 ng/ml needs additional measurements and consideration of other risk factors for management decision to avoid overtreatment. uPSA monitoring may spare high risk disease patients adjuvant radiation therapy for more selective early salvage radiation. There is currently no data that demonstrates improvement in survival following early salvage therapy prompted by uPSA surveillance.
CONCLUSIONS: uPSA is useful in the early diagnosis of cancer recurrence after RP. Its specificity, however, is poor. To date, there is lack of evidence that earlier detection of recurrence translates into prolonged time to metastasis. Integration of uPSA with other clinicopathologic factors can help determine optimal utilization of adjuvant and salvage therapy.
Tilki D, Kim SI, Hu B, Dall'Era MA, Evans CP. Are you the author?
Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA; Department of Urology, Ajou University School of Medicine, Suwon, Korea.
Reference: J Urol. 2014 Oct 22. pii: S0022-5347(14)04768-5.