Parameters derived from the postoperative decline in ultrasensitive PSA improve the prediction of radical prostatectomy outcome

Veselý, Štěpán; Jarolı́m, L; Schmidt, Marek; Minárik, I.; Dušek, Pavel; Babjuk, Marko

doi:10.1007/s00345-012-0892-3

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…Overall 15% of patients in the high risk treatment group had suspected BCR, lower than the 18% to 32% recurrence rate for patients not receiving TRT after RP during a comparable followup period. 19–22 Moreover, the recurrence rate was higher in the high risk treatment group than in the high risk reference group, with no men with BCR in the nonhigh risk subgroups.…”

Section: Discussionmentioning

confidence: 94%

Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical Prostatectomy

et al. 2013

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Purpose Testosterone replacement therapy in men with prostate cancer is controversial, with concern that testosterone can stimulate cancer growth. We evaluated the safety and efficacy of testosterone in hypogonadal men with prostate cancer treated with radical prostatectomy. Materials and Methods We performed a review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy (treatment group) and 49 nonhypogonadal men with cancer treated with prostatectomy (reference group). There were 77 men with low/intermediate (nonhigh) risk cancer and 26 with high risk cancer included in the analysis. All men were treated with transdermal testosterone, and serum hormone, hemoglobin, hematocrit and prostate specific antigen were evaluated for more than 36 months. Results Median (IQR) patient age in the treatment group was 61.0 years (55.0–67.0), and initial laboratory results included testosterone 261.0 ng/dl (213.0–302.0), prostate specific antigen 0.004 ng/ml (0.002–0.007), hemoglobin 14.7 gm/dl (13.3–15.5) and hematocrit 45.2% (40.4–46.1). Median followup was 27.5 months, at which time a significant increase in testosterone was observed in the treatment group. A significant increase in prostate specific antigen was observed in the high risk and nonhigh risk treatment groups with no increase in the reference group. Overall 4 and 8 cases of cancer recurrence were observed in treatment and reference groups, respectively. Conclusions Thus, testosterone therapy is effective and, while followed by an increase in prostate specific antigen, does not appear to increase cancer recurrence rates, even in men with high risk prostate cancer. However, given the retrospective nature of this and prior studies, testosterone therapy in men with history of prostate cancer should be performed with a vigorous surveillance protocol.

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Section: Discussionmentioning

confidence: 94%

Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical Prostatectomy

et al. 2013

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“…Indeed, previous studies have reported TTN as 2.0–3.3 months after RP. 4, 12, 22 If confirmed in future studies, for patients where the early post-operative PSA value is crucial to deciding on adjuvant radiation or not and the PSA is detectable, but below the threshold of recurrence (i.e. ≤0.2 ng/ml), it may be reasonable to give more time for the PSA to decline before documenting a nadir, which may spare some patients from needless radiation.…”

Section: Commentsmentioning

confidence: 88%

“…20 A single-institution study of 319 men found that PSA nadir >0.1 ng/mL and TTN <3 months are independent predictors of BCR. 12 However, the authors did not stratify by both PSA nadir and TTN. When analyzed in our data, we found men with a detectable nadir and a shorter TTN had the greatest risk of BCR.…”

Section: Commentsmentioning

confidence: 90%

“…11 However, to date only one small study of 319 men has examined the prognostic utility of TTN after RP. 12 Moreover, given the most widely accepted definition for BCR is a PSA >0.2 ng/ml, it is not uncommon for the first PSA level in the early postoperative setting to be detectable but <0.2 ng/ml. Whether some of these men later on achieve an undetectable PSA is unknown and whether for those men, their outcomes are comparable to men whose first PSA is undetectable is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Timing of Prostate-specific Antigen Nadir After Radical Prostatectomy and Risk of Biochemical Recurrence

Howard

Aronson

Terris

et al. 2017

Urology

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Objectives: To evaluate the association between PSA nadir level and time to nadir (TTN) with biochemical recurrence (BCR) risk after radical prostatectomy (RP) in the SEARCH database. Methods: Retrospective analysis of 1,939 men from the SEARCH database treated with RP between 1998–2015 with available ultrasensitive PSA nadir within 1–6 months after RP. Uni- and multivariable analyses of PSA nadir and TTN with time from nadir to BCR were done with Cox models (adjusted for demographics, tumor features and preoperative PSA). Results: Among men with an undetectable PSA nadir, the TTN was unrelated to BCR (1–2.9 vs. 3–6 months: HR 0.86, p=0.46). Regardless of TTN, men with detectable nadir had increased risk of BCR (TTN 3–6 months: HR 1.81, p=0.024; TTN 1–2.99 months: HR 3.75, p<0.001 vs. undetectable nadir and TTN 3–6 months). Among men with a detectable PSA at 1–3 months, 53% had a lower follow-up PSA 3–6 months after RP which was undetectable in 32% and lower but still detectable in 21%. Conclusions: In the post-RP setting, men with both a detectable nadir and a shorter TTN had an increased risk of BCR. Intriguingly, about half of the men with a detectable PSA in the first 3 months after RP had a lower follow-up PSA between 3 and 6 months after RP. If confirmed in future studies, this has important implications for patients considering adjuvant therapy based upon post-operative PSA values in the first 3 months after RP.

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“…Two articles used the UCLA‐Prostate Cancer Index (UCLI‐PCI) to assess continence in their cohort. Published in 1998, the UCLA‐PCI was one of the first health‐related QOL tools available to assess men who underwent treatment for prostate cancer . It attempted to more accurately characterize this group of patients with prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

‘Trifecta’ after radical prostatectomy: is there a standard definition?

et al. 2013

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Objectives To determine the extent of variability in the definitions of the ‘trifecta’ after radical prostatectomy (undetectable PSA, urinary continence and potency) to be found in the literature. To establish a consensus definition of the trifecta in an effort to standardize criteria and reporting. Materials and Methods A systematic review of published articles found in the PubMed database for the period from January 2003 to March 2012 was performed. The search queries included the keywords ‘radical prostatectomy,’ ‘prostatectomy outcome,’ and ‘trifecta’. Results A total of 86 publications were identified of which 14 were used for analysis. Eight different definitions of biochemical recurrence were reported, the most common definition being PSA ≥0.2 ng/mL. The definition of potency was the most variable. Ten different definitions of potency were found, with the most common being ‘having erections sufficient for intercourse with or without a phosphodiesterase‐5 inhibitor’. Nine different definitions of continence were found. The most common definition of continence was ‘wearing no pads’. Only six of the 14 articles used validated questionnaires in their outcome measures. Conclusions The definitions of trifecta reported in the literature are highly variable. We propose the following consensus definition based on our analysis: (1) PSA >0.2 ng/mL with confirmatory value; (2) attainment of erections sufficient for intercourse with or without oral pharmacological agents; (3) wearing zero pads. This consensus definition should be considered when designing studies and reporting outcomes of radical prostatectomy.

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Parameters derived from the postoperative decline in ultrasensitive PSA improve the prediction of radical prostatectomy outcome

Abstract: Our results demonstrate that the level of PSA nadir and the time to PSA nadir determined by ultrasensitive assay significantly improve the identification of patients who are at high risk of disease recurrence after RP.

Cited by 14 publications

References 20 publications

Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical Prostatectomy

Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical Prostatectomy

Timing of Prostate-specific Antigen Nadir After Radical Prostatectomy and Risk of Biochemical Recurrence

‘Trifecta’ after radical prostatectomy: is there a standard definition?

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