title: Three-year postoperative ultrasensitive prostate-specific antigen following open radical retropubic prostatectomy is a predictor for delayed biochemical recurrence.
abstract: BACKGROUND
  Prostate-specific antigen (PSA) is the only independent predictor of biochemical recurrence (BCR) following radical prostatectomy (RP) subject to change over time.
  
  
  OBJECTIVE
  To determine whether an ultrasensitive PSA measured at 3 yr following RP is a predictor of subsequent BCR.
  
  
  METHODS
  There were 1197 consecutive men with clinically localized prostate cancer who underwent an open radical retropubic prostatectomy (ORRP) at a tertiary referral academic medical center. Exclusions included 107 men (8.9%) who developed a PSA level ≥ 0.2 ng/ml or underwent hormone therapy or radiation therapy (RT) within the first 3 r after surgery, 191 men (16%) who did not undergo a 3-yr ultrasensitive PSA assay, and 98 men (8.2%) who had PSA levels ≥ 0.1 and <0.2 at 3 yr. The remaining 801 men were stratified into two groups based on their ultrasensitive PSA level at 3 yr postoperatively: group 1, which consisted of patients whose PSA was ≤ 0.04 (n = 765), and group 2, which consisted of patients whose PSA was >0.04 and <0.10 (n = 36).
  
  
  METHODS
  Delayed BCR was the primary end point and represented those men in this cohort who developed a PSA level ≥ 0.2 or underwent salvage RT for a persistently rising PSA level after 3 yr of follow-up.
  
  
  CONCLUSIONS
  The 7-yr cumulative BCR-free survival rate for groups 1 and 2 was 0.957 (95% confidence interval [CI], 0.920-0.978) and 0.654 (95% CI, 0.318-0.855), respectively. In multivariable Cox proportional hazards models, ultrasensitive PSA level at 3 yr remained the only significant predictor of delayed BCR (likelihood ratio χ(2) for full model: 27.03; df = 1; p < 0.001). A limitation of the study is that no uniform PSA assay was obtained.
  
  
  CONCLUSIONS
  Our findings provide compelling evidence that an ultrasensitive PSA at 3 yr following RP provides useful insights into delayed BCR and is a source of reassurance for the overwhelming majority of men being followed for delayed recurrences.
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Rena D
authors.initials: RD
authors.lastname: Malik
authors.forename: Judith D
authors.initials: JD
authors.lastname: Goldberg
authors.forename: Tsivia
authors.initials: T
authors.lastname: Hochman
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
mesh_terms: D000046:Academic Medical Centers; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009519:New York City; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen