Ultrasensitive Prostate Specific Antigen and its Role after Radical Prostatectomy: A Systematic Review

Tilki, Derya; Kim, Sun Il; Hu, Brian; Dall′Era, Marc; Evans, Christopher P.

doi:10.1016/j.juro.2014.10.087

Cited by 25 publications

(27 citation statements)

References 32 publications

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“…uPSA may be useful to predict early disease recurrence (27) and determine patient followup protocol. However, it is still unclear whether earlier detection of BCR translates into prolonged time to metastasis (14). Although the patients with postoperative early uPSA value >0.02 ng/ml had worse metastatic-free survival in this study, the limitations include the relatively small rate of metastatic recurrence and the limited followup period.…”

Section: Discussionmentioning

confidence: 80%

“…Conventional PSA assays have been applied to detect BCR, in which the detection threshold of 0.2 ng/ml was considered adequate to detect BCR (13). The uPSA was established to detect PSA with a lower limit of detection <0.1 ng/ml (14). Although the clinical usefulness of the uPSA after radical prostatectomy is still unclear, uPSA may have the potential to sensitively predict BCR with a lead time advantage over that of the conventional relapse definition (15).…”

Section: Introductionmentioning

confidence: 99%

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Postoperative early ultrasensitive prostate-specific antigen identifies patients at risk for biochemical recurrence in margin positive prostate cancers: a single-center study

Hatano

Okusa

Ishizuya

et al. 2017

Japanese Journal of Clinical Oncology

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Objective: To identify predictors for biochemical recurrence among patients with positive surgical margins (RM1) after radical prostatectomy and to examine the effect of ultrasensitive prostatespecific antigen measured early after prostatectomy on biochemical recurrence. Methods: We identified 705 patients with prostate cancer who were treated with radical prostatectomy without preoperative hormonal therapy at our institution between 2000 and 2014. The patients with RM1 who had a postoperative prostate-specific antigen <0.2 ng/ml without lymph node metastasis were evaluated for biochemical recurrence-free survival. Survival rates were calculated using the Kaplan-Meier method. The Cox regression model was used for multivariate analysis. The prediction of biochemical recurrence was assessed using area under the curve of the receiver operating characteristic. Results: Among the 705 patients, 190 (27%) had RM1. Biochemical recurrence was evaluated in 164 patients, excluding 26 patients who underwent adjuvant therapy with or without lymph node metastasis. With a median follow-up of 55 months, the biochemical recurrence-free survival rate of the entire RM1 cohort was 78% at 2 years and 64% at 4 years. The multivariate analysis revealed that postoperative early ultrasensitive prostate-specific antigen >0.02 ng/ml was the significant risk factor for biochemical recurrence (hazard ratio 13.10). Meanwhile, the patients with postoperative early ultrasensitive prostate-specific antigen <0.01 ng/ml had a significantly lower risk for biochemical recurrence (hazard ratio 0.12). Area under the curve for the postoperative early ultrasensitive prostate-specific antigen value to predict biochemical recurrence was 0.789. Conclusions: The ultrasensitive prostate-specific antigen value measured early after prostatectomy was the potent predictor of biochemical recurrence among the patients with RM1.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Postoperative early ultrasensitive prostate-specific antigen identifies patients at risk for biochemical recurrence in margin positive prostate cancers: a single-center study

Hatano

Okusa

Ishizuya

et al. 2017

Japanese Journal of Clinical Oncology

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“…Currently, there is no evidence that salvage RT prompted by elevated u-PSA values after RP would improve patient survival. Nevertheless, it could save high-risk patients from unnecessary adjuvant RT and favor more selective salvage RT7.…”

mentioning

confidence: 99%

Longitudinal modeling of ultrasensitive and traditional prostate-specific antigen and prediction of biochemical recurrence after radical prostatectomy

Laajala

Seikkula²,

Seyednasrollah

et al. 2016

Sci Rep

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Ultrasensitive prostate-specific antigen (u-PSA) remains controversial for follow-up after radical prostatectomy (RP). The aim of this study was to model PSA doubling times (PSADT) for predicting biochemical recurrence (BCR) and to capture possible discrepancies between u-PSA and traditional PSA (t-PSA) by utilizing advanced statistical modeling. 555 RP patients without neoadjuvant/adjuvant androgen deprivation from the Turku University Hospital were included in the study. BCR was defined as two consecutive PSA values >0.2 ng/mL and the PSA measurements were log2-transformed. One third of the data was reserved for independent validation. Models were first fitted to the post-surgery PSA measurements using cross-validation. Major trends were then captured using linear mixed-effect models and a predictive generalized linear model effectively identified early trends connected to BCR. The model generalized for BCR prediction to the validation set with ROC-AUC of 83.6% and 95.1% for the 1 and 3 year follow-up censoring, respectively. A web-based tool was developed to facilitate its use. Longitudinal trends of u-PSA did not display major discrepancies from those of t-PSA. The results support that u-PSA provides useful information for predicting BCR after RP. This can be beneficial to avoid unnecessary adjuvant treatments or to start them earlier for selected patients.

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“…17 Study limitations include the retrospective nature, evaluation of a single measurement, and dependence on specimen availability. The study group however was representative of the population at large.…”

Section: Discussionmentioning

confidence: 99%

“…17 Therefore, in this investigation we reexamined ultrasensitive PSA assays for predicting long-term BCR-free survival in 754 men subsequent to RP. We additionally determined the distribution of PSA values in men post-cystoprostatectomy with no pathological evidence of prostate cancer in order to assess the potential for false-positive results due to background or non-prostatic sources of PSA.…”

Section: Introductionmentioning

confidence: 99%

Do Ultrasensitive Prostate Specific Antigen Measurements Have a Role in Predicting Long-Term Biochemical Recurrence-Free Survival in Men after Radical Prostatectomy?

et al. 2016

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In men with a serum prostate specific antigen less than 0.1 ng/ml after radical prostatectomy a tenfold lower cutoff (0.01 ng/ml) stratified biochemical recurrence-free survival and was a significant independent predictor of biochemical recurrence, as were pathological features. Prostate specific antigen concentrations in men without pathological evidence of prostate cancer suggest that a higher prostate specific antigen concentration (0.03 ng/ml) in the ultrasensitive range may be needed to define the detection threshold.

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Ultrasensitive Prostate Specific Antigen and its Role after Radical Prostatectomy: A Systematic Review

Cited by 25 publications

References 32 publications

Postoperative early ultrasensitive prostate-specific antigen identifies patients at risk for biochemical recurrence in margin positive prostate cancers: a single-center study

Postoperative early ultrasensitive prostate-specific antigen identifies patients at risk for biochemical recurrence in margin positive prostate cancers: a single-center study

Longitudinal modeling of ultrasensitive and traditional prostate-specific antigen and prediction of biochemical recurrence after radical prostatectomy

Do Ultrasensitive Prostate Specific Antigen Measurements Have a Role in Predicting Long-Term Biochemical Recurrence-Free Survival in Men after Radical Prostatectomy?

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