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

  • Stephanie L. Skove
    Affiliations
    Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC
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  • Lauren E. Howard
    Affiliations
    Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC

    Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
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  • William J. Aronson
    Affiliations
    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
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  • Martha K. Terris
    Affiliations
    Urology Section, Division of Surgery, Veterans Affairs Medical Centers and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA
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  • Christopher J. Kane
    Affiliations
    Department of Urology, University of California at San Diego Medical Center, San Diego, CA
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  • Christopher L. Amling
    Affiliations
    Department of Urology, Oregon Health & Science University, Portland, OR
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  • Matthew R. Cooperberg
    Affiliations
    Departments of Urology and Epidemiology & Biostatistics, University of California, San Francisco, CA

    Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA
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  • Daniel M. Moreira
    Affiliations
    Department of Urology, University of Illinois at Chicago, Chicago, IL
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  • Stephen J. Freedland
    Correspondence
    Address correspondence to: Stephen J. Freedland, M.D., Department of Surgery, Division of Urology and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8635 West 3rd Street Suite 1070W, Los Angeles, CA 90048.
    Affiliations
    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
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      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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