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Freedom From a Detectable Ultrasensitive Prostate-specific Antigen at Two Years After Radical Prostatectomy Predicts a Favorable Clinical Outcome: Analysis of the SEARCH Database

2009; Elsevier BV; Volume: 75; Issue: 2 Linguagem: Inglês

10.1016/j.urology.2009.06.089

1527-9995

Steven L. Chang, Stephen J. Freedland, Martha K. Terris, William J. Aronson, Christopher J. Kane, Christopher L. Amling, Joseph C. Presti,

Statistical Methods in Clinical Trials

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).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.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.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.