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Urology. 2017 Oct;108:129-134. doi: 10.1016/j.urology.2017.07.009. Epub 2017 Jul 19.

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

Author information

1
Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC.
2
Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
3
Urology Section, Department of Surgery, Veterans Affairs Medical Center, Greater Los Angeles, Los Angeles, CA; Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA.
4
Urology Section, Division of Surgery, Veterans Affairs Medical Centers and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA.
5
Department of Urology, University of California at San Diego Medical Center, San Diego, CA.
6
Department of Urology, Oregon Health & Science University, Portland, OR.
7
Departments of Urology and Epidemiology & Biostatistics, University of California, San Francisco, CA; Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA.
8
Department of Urology, University of Illinois at Chicago, Chicago, IL.
9
Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC; Department of Surgery, Division of Urology and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Center for Integrated Research in Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Stephen.freedland@cshs.org.

Abstract

OBJECTIVE:

To evaluate the association between the prostate-specific antigen (PSA) nadir level and the time to nadir (TTN) with biochemical recurrence (BCR) risk after radical prostatectomy (RP) in the Shared Equal-Access Research Cancer Hospital (SEARCH) database.

MATERIALS AND METHODS:

This is a retrospective analysis of 1939 men from the SEARCH database treated with RP between 1998 and 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 performed 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 (1.0-2.9 vs 3-6 months: hazard ratio [HR] 0.86, P = .46). Regardless of TTN, men with detectable nadir had an increased risk of BCR (TTN of 3-6 months: HR 1.81, P = .024; TTN of 1.0-2.99 months: HR 3.75, P <.001 vs undetectable nadir and TTN of 3-6 months). Among men with a detectable PSA at 1-3 months, 53% had a lower PSA level during follow-up 3-6 months after RP, which was undetectable in 32% and lower but still detectable in 21%.

CONCLUSION:

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 PSA level during follow-up between 3 and 6 months after RP. If confirmed in future studies, this has important implications for patients considering adjuvant therapy based on postoperative PSA values in the first 3 months after RP.

PMID:
28735016
PMCID:
PMC6150912
DOI:
10.1016/j.urology.2017.07.009
[Indexed for MEDLINE]
Free PMC Article

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