Prostate specific antigen nadir determined using ultra‐sensitive prostate specific antigen as a predictor of biochemical progression after radical prostatectomy in Japanese males

Abstract

Objectives:We examined whether the prostate specific antigen (PSA) nadir is a good predictor of biochemical failure after radical prostatectomy. Methods: We retrospectively reviewed clinico-pathological data in 257 patients who underwent radical prostatectomy. Twenty-nine patients of whom PSA nadir did not reach 0.1 ng/mL and three patients in whom second line therapy was started before biochemical failure were excluded , and 225 patients were subject to this study. We evaluated the changes in PSA value at very low (from less than 0.01-0.10 ng/mL) levels using an ultra-sensitive PSA assay after radical prostatectomy. Biochemical failure was defined as three consecutive elevations of PSA to above 0.1 ng/mL. Results: Biochemical failure-free survival was attained by 89.9% of patients at 1 year, 83.0% at 2 years, and 81.0% at 5 years. PSA nadir more than 0.01 ng/mL was strongly associated with biochemical failure after radical prostatectomy (P < 0.0001). Mean time to reach PSA nadir was 3.1 months. Preoperative PSA > 20 ng/mL (P = 0.0013), clinical T stage = T2 (P = 0.0462), Gleason score 8-10 (P = 0.0243) were also independent predictors of biochemical progression. Conclusions: Prostate specific antigen nadir determined by ultra-sensitive PSA assay is an important parameter that is objective, reliable, and easily measured , and useful for predicting the subgroups of patients both most likely and unlikely to exhibit biochemical progression.

Usefulness of ultra-sensitive prostate-specific antigen following radical prostatectomy

“…From these results, we may hypothesize that the group with a PSA nadir of <0.008 ng/ml following RP was significantly less likely to experience biochemical failure compared to the group with PSA ≥0.008 ng/ml. Kinoshita et al (2) reported that cases where the PSA nadir value does not decrease to ≤0.01 ng/ml postoperatively using the ultra-sensitive method, are at a significant risk of PSA recurrence (>0.1 ng/ml), which is consistent with our findings. Yu et al (4) classed reagents with an ultra-sensitive PSA detection threshold value of 0.1-0.3 ng/ml as first-generation, those of 0.02-0.1 ng/ml as second-generation and those of 0.001-0.02 ng/ml as third-generation.…”

“…In particular, PSA is most effective when used as a post-treatment monitor. In cases of radical prostatectomy (RP), the mere detection of PSA postoperatively is highly likely to signify residual lesions (2). In addition, postoperative follow-up of prostate cancer cases is currently implemented mainly by using PSA and rectal examination.…”

Risk factors predicting the outcome of salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy

“…These cells might be localized, disseminated or both, which cannot be detected by imaging studies at lower PSA levels. We previously showed that a PSA nadir after radical prostatectomy of >0.01 ng/mL, which was obtained within 3 months in many cases, is a strong predictor for biochemical progression after surgery . Several reports showed that a persistently detectable PSA level of >0.2 ng/mL after radical prostatectomy is an adverse parameter of biochemical progression after salvage RT .…”

Postoperative prostate‐specific antigen nadir improves accuracy for predicting biochemical recurrence after radical prostatectomy: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center databases

“…We have previously shown that postoperative PSA nadir is highly associated with disease recurrence 9 and overall survival, 10 being potentially useful in risk assessment. However, to date, only a few limited studies evaluated the predictive properties of postoperative PSA nadir 27,28 . Therefore, we sought to explore the predictive characteristics of PSA nadir and the effect of including nadir into commonly used models and nomograms on their accuracy to predict BCR after RP.…”