title: Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival.
abstract: Radical retropubic prostatectomy is considered by many centres to be the treatment of choice for men aged less than 70 years with localized prostate cancer. A rise in serum prostate-specific antigen after radical prostatectomy occurs in 10-40% of cases. This study evaluates the usefulness of novel ultrasensitive PSA assays in the early detection of biochemical relapse. 200 patients of mean age 61. 2 years underwent radical retropubic prostatectomy. Levels < or = 0.01 ng ml-1 were considered undetectable. Mean pre-operative prostate-specific antigen was 13.3 ng ml-1. Biochemical relapse was defined as 3 consecutive rises. The 2-year biochemical disease-free survival for the 134 patients with evaluable prostate-specific antigen nadir data was 61.1% (95% CI: 51.6-70.6%). Only 2 patients with an undetectable prostate-specific antigen after radical retropubic prostatectomy biochemically relapsed (3%), compared to 47 relapses out of 61 patients (75%) who did not reach this level. Cox multivariate analysis confirms prostate-specific antigen nadir < or = 0.01 ng ml-1 to be a superb independent variable predicting a favourable biochemical disease-free survival (P < 0.0001). Early diagnosis of biochemical relapse is feasible with sensitive prostate-specific antigen assays. These assays more accurately measure the prostate-specific antigen nadir, which is an excellent predictor of biochemical disease-free survival. Thus, sensitive prostate-specific antigen assays offer accurate prognostic information and expedite decision-making regarding the use of salvage prostate-bed radiotherapy or hormone therapy.
authors.affiliation: Department of Urology, Charing Cross Hospital, Fulham Palace Road, London.
authors.forename: A P
authors.initials: AP
authors.lastname: Doherty
authors.forename: M
authors.initials: M
authors.lastname: Bower
authors.forename: G L
authors.initials: GL
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Miano
authors.forename: E M
authors.initials: EM
authors.lastname: Mannion
authors.forename: H
authors.initials: H
authors.lastname: Mitchell
authors.forename: T J
authors.initials: TJ
authors.lastname: Christmas
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000276:immunology* / Q000473:pathology / Q000601:surgery*; D016879:Salvage Therapy; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen