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

Abstract

Abstract. This study aimed to evaluate the usefulness of ultra-sensitive prostate-specific antigen (PSA) following radical prostatectomy (RP). Between September, 2003 and March, 2009, a total of 311 prostate cancer patients underwent antegrade RP; following the exclusion of 111 patients due to prior hormonal therapy, 200 patients were finally included in this study. The results of the multivariate analysis identified RP Gleason score, extraprostatic extension, lymph node metastasis and PSA nadir as significant predictors of biochemical failure (P=0.0116, 0.0216, 0.0178 and <0.0001, respectively) and PSA nadir <0.008 ng/ml exhibited the highest hazard ratio (HR) [HR=26.34; 95% confidence interval (CI): 7.34-104.69]. After a median follow-up period of 52.2 months, the biochemical failure-free rate in the PSA nadir <0.008 and ≥0.008 ng/ml groups was 94.3 and 58.8%, respectively, with a statistically significant difference according to the log-rank test (P<0.001). In the multivariate analysis, statistically significant differences were observed only in pathological nodel stage within the PSA nadir <0.008 ng/ml group (P=0.0107). For this reason, postoperative follow-up using ultra-sensitive PSA is considered to be of value, since the use of high-sensitivity PSA to confirm a reduction to below postoperative measurement threshold value (PSA nadir <0.008 ng/ml) may avert administering unnecessary additional treatment, regardless of pathological reccurrence factors.

The use of 68 Ga‐PSMA PET CT in men with biochemical recurrence after definitive treatment of acinar prostate cancer

“…An international consensus agrees that after RP, recurrent cancer may be defined by two consecutive PSA values of >0.2 ng/mL and rising . The development of ultrasensitive PSA assays have improved detection levels down to 0.008 ng/mL . The ability to detect recurrent prostate cancer in the ultrasensitive PSA range <0.2 may lead to greater interest in adoption of earlier salvage treatment.…”

Biochemical recurrence after radical prostatectomy: Current status of its use as a treatment endpoint and early management strategies

“…One retrospective study demonstrated the usefulness of supersensitive PSA values by correlating a PSA nadir of ≤0.008 versus ≥0.008 (a value only attainable through supersensitive PSA values) with a lower probability of BCR. [ 12 ] Furthermore, the utility of BCR is restricted to measuring the outcomes of primary treatment and cannot be used to time the initiation of salvage therapies. [ 13 ] Identification of BCR as a standalone benchmark is fairly nonspecific as it does little to detail the origin of biochemical failure and the extent of disease recurrence, though some studies suggest that metastatic relapse is better predicted with a cut-point of ≥0.4 ng/mL.…”

Prostate cancer trajectory-map: clinical decision support system for prognosis management of radical prostatectomy

“… 6 , 7 Furthermore, ultrasensitive monitoring of PSA kinetics is an important method to identify patients requiring additional treatment. 8 …”