Freedom From a Detectable Ultrasensitive Prostate-specific Antigen at Two Years After Radical Prostatectomy Predicts a Favorable Clinical Outcome: Analysis of the SEARCH Database - 20/08/11

Doi : 10.1016/j.urology.2009.06.089

Steven L. Chang ^a,^b,^⁎ , Stephen J. Freedland ^c,^d, Martha K. Terris ^e,^f, William J. Aronson ^g,^h, Christopher J. Kane ⁱ, Christopher L. Amling ^j, Joseph C. Presti ^a,^b
^a Department of Urology, Stanford University Medical Center, Stanford, California
^b Urology Section, Department of Surgery, Veterans Affairs Medical Center, Palo Alto, California
^c Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina
^d Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
^e Urology Section, Department of Surgery, Veterans Affairs Medical Center, Augusta, Georgia
^f Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia
^g Urology Section, Department of Surgery, Veterans Affairs Medical Center Los Angeles, California
^h Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, California
ⁱ Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, California
^j Division of Urology, Department of Surgery, Oregon Health & Science University, Portland, Oregon

Reprint requests: Steven L. Chang, M.D., Department of Urology, Stanford University, 300 Pasteur Dr, Stanford, CA 94305

Résumé

Objectives

To assess the utility of kinetics for ultrasensitive prostate-specific antigen (uPSA) assays to identify men who are at risk of developing high-risk recurrent prostate cancer [prostate-specific antigen doubling time (PSADT) < 9 months] after radical prostatectomy. Previous studies demonstrate that a PSADT < 9 months after radical prostatectomy is associated with prostate cancer-specific mortality. Conventionally, PSADT has been calculated after biochemical failure (PSA ≥ 0.2 ng/mL).

Methods

A review of the Shared Equal Access Regional Cancer Hospital database from 1988-2008 was performed to identify men with biochemical failure after radical prostatectomy and ≥ 2 uPSA values before failure (PSA ≥ 0.2 ng/mL) as well as ≥ 2 values after failure to calculate PSADT. These patients were stratified into low-risk (PSADT ≥ 9 months) and high-risk (PSADT < 9 months) cohorts. The following uPSA kinetics were analyzed for their ability to predict low- and high-risk cohorts: time to first detectable uPSA, time from uPSA to biochemical failure, uPSA velocity, uPSADT, uPSA exponential rise, and uPSA fluctuations.

Results

The analysis included 89 low- and 26 high-risk men. Time to first detectable uPSA was inversely associated with the high-risk cohort (OR 0.96, 95% CI 0.92-0.99, P = .02) and characterized by a high sensitivity and negative predictive value at a threshold of 2 years after surgery. Other measures of uPSA kinetics showed no association with PSADT.

Conclusions

Time to first detectable uPSA identifies men with low-risk recurrence prostate cancer. Patients with an undetectable uPSA 2 years after surgery are unlikely to develop PSADT < 9 months after biochemical failure.

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Plan

Material and Methods

Study Population

Ultrasensitive PSA Kinetics

Statistical Analysis

Results

Characteristics of the Study Cohorts

Analysis of Ultrasensitive PSA Kinetics

Comment

Limitations

Conclusions

Christopher J. Kane is a consultant for Intuitive Surgical, Inc. Joseph C. Presti Jr is a consultant for Gen-Probe and works as an investigator for NCI.