Patients who have detectable PSA levels immediately after radical prostatectomy (RP) for prostate cancer (PCa) have good cancer-specific survival over 10 years, according to new study findings presented at the 20th annual meeting of the Society of Urologic Oncology in Washington DC.
Peter E. Lonergan MD, and colleagues from the University of California, San Francisco, analyzed data from 499 patients at their institution during 2000 to 2018 who had a PSA level exceeding 0.05 ng/mL at 2 to 6 months after RP. At diagnosis, patients had a median age of 62 years and median PSA of 7.95 ng/mL. Their median CAPRA-S score, incorporating pre- and post-surgical information, was 5.
At final pathology, 10%, 33%, 29%, and 28% of men had Gleason score 3+3, 3+4, 4+3, and 8 to 10, respectively. Pathologic T-stage was T2 in 40%, T3 in 57%, and T4 in 3%. At pathology, 16% of men had positive lymph nodes.
Of the original 499 patients, 203 (59%) underwent salvage treatment at a median of 5 months. At a median of 7 months, 33 of these men required further treatment (androgen deprivation therapy for 31 and salvage radiotherapy for 2), including 10 for bone metastases.
Treatment-free survival after post-RP salvage in patients with detectable vs undetectable PSA was 86% vs 92% at 1 year, 78% vs 89% at 3 years, 72% vs 86% at 5 years and 70% vs 76% at 10 years.
PCa-specific survival among men with a detectable vs undetectable PSA was 100% and 100%, respectively, at 1 year, 99% and 100% at 3 years, 96% and 100% at 5 years, and 91% and 99% at 10 years.
“We demonstrate that men with a detectable PSA after RP may have excellent long-term outcomes,” Dr Lonergan’s team concluded.
Lonergan PE, Washington SL, Cowan JE, et al. Natural history of an immediately detectable PSA following radical prostatectomy: a description of a contemporary cohort. Presented at the 20th annual meeting of the Society of Urologic Oncology. December 4-6, 2019. Washington DC. Poster 105.