title: Determining When to Stop Prostate Specific Antigen Monitoring after Radical Prostatectomy: the Role of Ultrasensitive Prostate Specific Antigen.
abstract: We analyzed long-term followup data after radical prostatectomy to determine how long we should follow patients in whom the serum prostate specific antigen level measured by an ultrasensitive assay was consistently low.
  
  
  
  We retrospectively reviewed clinicopathological data for 582 consecutive patients who underwent open or laparoscopic radical prostatectomy between 1995 and 2004, excluding 4 patients who received adjuvant therapy. We stratified the patients according to prostate specific antigen at 3 and 5 years after surgery, and examined subsequent biochemical recurrence (elevation of prostate specific antigen to greater than 0.2 ng/ml) during followup. Mean followup was 9.7 years.
  
  
  
  At 3 years after surgery prostate specific antigen levels were measured by an ultrasensitive assay in 323 patients who had not experienced biochemical recurrence. In 187 patients with undetectable prostate specific antigen levels (less than 0.01 ng/ml) the 10 and 15-year biochemical recurrence-free survival rates were 99% and 96%, respectively. At 5 years after surgery prostate specific antigen was measured in 315 patients by the ultrasensitive assay. In 162 patients with undetectable prostate specific antigen levels the 10 and 15-year biochemical recurrence-free survival rates were both 100%. In this group the prostate specific antigen level at last followup was less than 0.01 ng/ml in 132 patients, 0.01 to 0.03 ng/ml in 27 patients, and 0.06 ng/ml, 0.07 ng/ml and 0.11 ng/ml in 1 patient each.
  
  
  
  This long-term review indicates that if patients have continuously undetectable prostate specific antigen levels by an ultrasensitive assay for 5 years, prostate specific antigen monitoring can be stopped with an extremely low risk of subsequent biochemical recurrence.
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kazz_matsumoto@yahoo.co.jp.
authors: Kazuhiro
authors: K
authors: Matsumoto
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Akari
authors: A
authors: Komatsuda
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Yoshinori
authors: Y
authors: Yanai
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Naoya
authors: N
authors: Niwa
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Takeo
authors: T
authors: Kosaka
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Ryuichi
authors: R
authors: Mizuno
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Eiji
authors: E
authors: Kikuchi
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Akira
authors: A
authors: Miyajima
authors: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors: Mototsugu
authors: M
authors: Oya
mesh_terms: D000368:Aged; D003657:Decision Making; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008991:Monitoring, Physiologic; D009364:Neoplasm Recurrence, Local / Q000097:blood; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen
keywords: follow-up studies; monitoring; physiologic; prostate-specific antigen; prostatectomy; recurrence