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We retrospectively reviewed clinicopathologic data of 772 consecutive patients who underwent RP between 2009 and 2017, excluding patients who received adjuvant therapy and those without a nadir PSA level less than 0.2 ng/ml. We examined all PSA values measured during the actual follow-up. Meanwhile, we estimated the PSA value when we observed the "optimal PSA follow-up schedule" at each timing of virtual follow-up. BCR was defined as an elevation of PSA to greater than 0.2 ng/ml. We considered that the ideal PSA range for detection of BCR should be set at 0.2 to 0.4 ng/mL in order to start salvage treatment without delay. Therefore, the primary objective of this study was to examine whether BCR could be detected before PSA exceeded 0.4 ng/mL when we complied with the "optimal PSA followup schedule". We also compared the frequency of virtual follow-up (PSA measurement) to that of actual.RESULTS: During the mean follow-up period of 5.8 years, 115 (14.9%) patients developed BCR and the frequency of virtual follow-up was significantly lower than the actual frequency (5.8 vs 13.5 times, p<0.001). However, BCR was overlooked (detecting BCR when PSA exceeded 0.4 ng/ml) in 17 (2.2%) patients, which was higher than the actual frequency of 12 (1.6%) patients. Therefore, we modified the follow-up schedule as shown in the lower of Table, which resulted in a significantly lower follow-up frequency (7.4 times, p<0.001) and less incidence of overlooking of BCR (7 patients, 0.9%).CONCLUSIONS: This external validation study revealed that the "modified optimal PSA follow-up schedule after RP" could reduce the frequency of PSA measurement with a limited risk of overlooking BCR. We believe this schedule could decrease medical expenses and the burden on both physicians and patients.

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