150 THE NATURAL HISTORY OF ULTRASENSITIVE PSA FOLLOWING RADICAL PROSTATECTOMY (2011)

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History1 Apr 2011150 THE NATURAL HISTORY OF ULTRASENSITIVE PSA FOLLOWING RADICAL PROSTATECTOMY David S. Finley, Steve Horvath, Christopher King, Alan Pantuck, Jeffrey LaRochelle, Matthew Rettig, William Aronson, Jean Dekernion, and Robert Reiter David S. FinleyDavid S. Finley Los Angeles, CA More articles by this author , Steve HorvathSteve Horvath Los Angeles, CA More articles by this author , Christopher KingChristopher King Los Angeles, CA More articles by this author , Alan PantuckAlan Pantuck Los Angeles, CA More articles by this author , Jeffrey LaRochelleJeffrey LaRochelle Portland, OR More articles by this author , Matthew RettigMatthew Rettig Los Angeles, CA More articles by this author , William AronsonWilliam Aronson Los Angeles, CA More articles by this author , Jean DekernionJean Dekernion Los Angeles, CA More articles by this author , and Robert ReiterRobert Reiter Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.218AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment failure following radical prostatectomy (RP) is usually associated with a measurable serum prostate specific antigen (PSA) level which often indicates persistent or recurrent cancer. 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. In this study, we evaluated a cohort of men who underwent RP and correlated their post-operative uPSA trends with clinicopathologic variables and BCR. METHODS A retrospective review was performed to capture men who underwent RP with at least 2 post-RP uPSA values obtained at our Institution (Roche electrochemiluminescence or Hybritech Beckman Coulter). Men who received neoadjuvant androgen deprivation therapy, radiotherapy, or with node positive disease were excluded. The initial post-RP uPSA (uPSAINITIAL) was obtained at approximately 3 months and regularly thereafter. Undetectable was defined as <0.01 ng/mL and treatment failure as [uPSA >0.1ng/mL or salvage radiotherapy (XRT)]. RESULTS 319 men were evaluated over a median follow-up of 51.4 months (range 3.4–114.0 mo). Overall, 232 men (72.7%) had an undetectable uPSA-INITIAL, 40 (17.2%) of which 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; p=<0.0001; perineural invasion: 79.4% vs 46.7%, p = 0.002; tumor size: 2.5cm vs 1.8cm, p = 0.045; pT3: 32.5% vs. 5.7%, p<0.0001), higher median uPSA-First detectable: 0.02 vs 0.01 ng/mL, p = 0.0001, and a more rapid med. time to detectable status: 15.9 mo vs. 24.8 mo, p = 0.008. On Cox multivariate analysis, the first detectable uPSA was an independent predictor of treatment failure (HR 1.81, p < 0.0001). Other independent predictors included pre-tx PSA (HR 1.08, p=0.009) and pStage (HR 1.5, p = 0.02). Kaplan-Meier plotting of BCR as a function of uPSA demonstrated significant discriminatory power at an uPSAfirst detectable of 0.03 ng/mL. CONCLUSIONS In our series, the first detectable uPSA was the strongest predictor of treatment failure after RP. An initial postoperative uPSA of > 0.03 ng/mL was highly predictive of progression to 0.1 ng/mL or XRT. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e63 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information David S. Finley Los Angeles, CA More articles by this author Steve Horvath Los Angeles, CA More articles by this author Christopher King Los Angeles, CA More articles by this author Alan Pantuck Los Angeles, CA More articles by this author Jeffrey LaRochelle Portland, OR More articles by this author Matthew Rettig Los Angeles, CA More articles by this author William Aronson Los Angeles, CA More articles by this author Jean Dekernion Los Angeles, CA More articles by this author Robert Reiter Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...