Medically and economically appropriate follow-up schedule for prostate cancer patients after radical prostatectomy.
BACKGROUND
Our goal was to determine the optimal frequency and method of follow-up after radical prostatectomy to minimize medical cost without adversely affecting patients.


METHODS
Two hundred and twenty-one patients who underwent a radical prostatectomy with or without adjuvant androgen deprivation from 1989 to 1999 were selected for the study. Eighty percent of the patients received postoperative androgen deprivation. Tumor recurrence was strictly defined as detectable serum prostate specific antigen (PSA) and/or clinical findings such as local tumor detection or bone metastasis. Thirty of 221 patients experienced tumor recurrence. Risk of tumor recurrence, procedures for detection of recurrence, and PSA doubling time after biochemical failure were analyzed.


RESULTS
None of the 30 patients who were examined showed definitive local recurrence or metastatic sites on the imaging study at the time of initial PSA detection, and there were no observed recurrences in the absence of detectable serum PSA. In patients who showed elevated PSA within 12 months after radical prostatectomy, PSA levels rapidly increased with doubling times ranging from 1.2 to 13.7 months. Excluding those patients, the doubling time of PSA levels ranged from 2.8 to 31.5 months.


CONCLUSIONS
Prostate specific antigen screening is sufficient to detect treatment failure after radical prostatectomy, irrespective of adjuvant hormone therapy. Based on the calculated doubling time, the longest advisable interval between checks of PSA levels is estimated to be four months within the first year after radical prostatectomy, and biannually or annually thereafter. Continuously elevated PSA levels or clinical symptoms indicate surveys for local recurrences and distant metastases.
Niwakawa
Masashi
M
Urology Division, National Cancer Center Hospital, 1-1 Tsikiji, 5 Chome, Chuo-ku, Tokyo 104-0045, Japan. mniwakaw@gan2.res.go.jp
Tobisu
Ken-ichi
K
Fujimoto
Hiroyuki
H
Matsuoka
Naoki
N
Kakizoe
Tadao
T
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005251:Fees, Medical; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors
D017430:Prostate-Specific Antigen