Undetectable PSA 10 Years Post-Op Predicts Low Risk of PSA Relapse

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SAN FRANCISCO—Prostate cancer patients who have undetectable PSA levels 10 years after undergoing a radical prostatectomy (RP) have a low likelihood of experiencing biochemical recurrence (BCR) of their cancer or of dying from the malignancy, according to researchers.

In a group of 1,593 patients who had undetectable PSA levels 10 years after surgery, Stacy Loeb, MD, and colleagues at Johns Hopkins Medical Institutions in Baltimore, examined the rate and predictors of BCR—defined as a PSA rise greater than 0.2 ng/mL—in the next 10 years.

Among men with organ-confined disease, the BCR rate at 20 years was 3.9%, for men with an RP Gleason score of 6, 12.3% for men with an RP Gleason score of 3 + 7, and 14.1% among those with an RP Gleason score of 4 + 3 or higher. The metastasis rate was 0%, 2.2%, and 0%, respectively. Co-investigator Ashley E. Ross, MD, also of Johns Hopkins, presented findings at the American Urological Association annual meeting.

For men with extracapsular disease, the BCR rate was 17.8%, 8.4%, and 25.7%, respectively, at 20 years; the metastasis rate was 0%, 7.9%, and 32.2%. For men with positive surgical margins, the BCR rate was 29.4%, 20.5%, and 32.1%, respectively; the metastasis rate was 0%, 7.9%, and 32.2%. In addition, no patient with undetectable PSA at 10 years died from prostate cancer within 20 years of surgery, Dr. Ross noted.

The authors concluded that patients who remain free from progression at 10 years post-operatively should be counseled that their risk of subsequent cancer-related morbidity and mortality is low.

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