title: Freedom from a detectable ultrasensitive prostate-specific antigen at two years after radical prostatectomy predicts a favorable clinical outcome: analysis of the SEARCH database.
abstract: OBJECTIVE
  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 > or = 2 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 > or = 2 uPSA values before failure (PSA > or = 2 0.2 ng/mL) as well as > or = 2 2 values after failure to calculate PSADT. These patients were stratified into low-risk (PSADT > or = 2 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.
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, California 94305, USA. slchang1@stanford.edu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Presti
mesh_terms: D016208:Databases, Factual; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000453:epidemiology; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen