Standardizing the definition for biochemical recurrence following radical prostatectomy: What PSA cutpoint best predicts a durable rise and subsequent systemic progression?

Multiple definitions of biochemical recurrence (BCR) for prostate cancer (CaP) exist following radical prostatectomy (RP) and variation continues in both CaP outcome reporting and secondary treatment initiation.

We reviewed long-term prostatectomy outcomes to assess the most appropriate PSA cutpoint that predicts future disease progression.

We identified 13,512 patients with cT1-2N0M0 CaP who underwent RP between 1987-2010. Single PSA cutpoint of 0. 2, 0. 3, 0. 4, and 0. 5ng/mL or greater as well as confirmatory PSA value definitions of >= 0. 2ng/mL followed by PSA >0. 2ng/mL and >=0. 4ng/mL followed by PSA > 0. 4ng/mL were tested. Continued PSA rise following designated cutpoint definition was estimated using cumulative incidence. The strength of association between BCR definitions and subsequent systemic progression (SP) were analyzed using Cox proportional hazard models and the O'Quigley event-based R(2).

At a median postoperative follow-up of 9. 1yrs (IQR 4. 9-14. 3) 5,041 patients developed a detectable PSA and 512 developed SP. After reaching the PSA cutpoint of 0. 2, 0. 3 and 0. 4ng/mL, the percentage of patients experiencing a continued PSA rise over 5 years was 61%, 67% and 74%, respectively, plateauing at 0. 4ng/mL. The strongest association between BCR and SP occurred using a single PSA cutpoint of 0. 4ng/mL or greater (HR 36; R(2) 0. 92).

A PSA cutpoint of >=0. 4ng/mL reflects the threshold at which a PSA rise becomes durable and shows the strongest correlation with subsequent SP. Consideration should be given to using a PSA of >=0. 4ng/mL as the standard BCR definition following RP.

The Journal of urology. 2015 Dec 22 [Epub ahead of print]

Amir Toussi, Suzanne B Stewart-Merrill, Stephen A Boorjian, Sarah P Psutka, R Houston Thompson, Igor Frank, Matthew K Tollefson, Matthew T Gettman, Rachel E Carlson, Laureano J Rangel, R Jeffrey Karnes

Department of Urology, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. , Department of Health Sciences Research, Mayo Clinic, Rochester, MN. , Department of Health Sciences Research, Mayo Clinic, Rochester, MN. , Department of Urology, Mayo Clinic, Rochester, MN. 

PubMed

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