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.
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Article info
Publication history
Published online: July 19, 2017
Accepted:
July 7,
2017
Received:
May 25,
2017
Footnotes
Research support: Department of Veterans Affairs, National Institute of Health R01CA100938 (WJA), NIH Specialized Programs of Research Excellence Grant P50 CA92131-01A1 (WJA), the Georgia Cancer Coalition (MKT), NIH K24CA160653.
Disclaimer: Views and opinions of, and endorsements by, the authors do not reflect those of the US Army or the Department of Veterans Affairs.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
