Optimal Post-Radical Prostatectomy Follow-up Schedule Proposed

SAN FRANCISCO—Researchers have proposed an optimal follow-up schedule for patients who have undergone radical prostatectomy (RP) for prostate cancer (PCa), according to a poster presentation at the American Urological Association 2018 annual meeting.

The schedule suggests PSA testing frequencies based on post-operative baseline PSA levels to detect biochemical recurrence (BCR) before PSA levels exceed 0.4 ng/mL. The investigators defined BCR an increase in PSA to a level greater than 0.2 ng/mL.

For example, for men who have a baseline PSA level of 0.1 ng/mL, PSA should be measured at 3-month intervals for the first post-operative year, 4-month intervals from post-operative years 1 to 2 years, 6-month intervals from post-operative years 2 to 3, and annually thereafter.

Kazuhiro Matsumoto, MD, of Keio University School of Medicine in Tokyo, and colleagues based the follow-up schedule on findings from a retrospective review of clinicopathological data from 779 patients who underwent RP from 1996 to 2008. They examined BCR rates and PSA doubling time (PSA-DT) after development of BCR at various times after RP.

During a mean follow-up period of 8.8 years, 179 patients experienced BCR, Dr Matsumoto’s team reported in a poster presentation. The BCR rate was 6% per year in the first year after RP and 6%, 3%, 3%, and 2% per year at 1–2 years, 2–3 years, 3–5 years, and 2% more than 5 years after RP, respectively. The minimum PSA-DT after BCR was 1.6, 2.4, 3.1, 6.1, and 6.4 months, respectively. “These minimum PSA-DTs were taken to indicate the optimal follow-up interval during each period after surgery,” the authors noted in their study abstract.

The investigators noted that monitoring PSA is indispensable for surveillance after radical treatment to identify patients who might need additional treatment after BCR. “Since early salvage therapy for recurrence is known to be advantageous, it is important to detect elevation of PSA without day,” they wrote. “However, unnecessarily intensive PSA follow-up could increase medical expenses and the burden on physicians and patients.”

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Reference

Matsumoto K, Hattori S, Miwa N, et al. Establishment of the optimal follow-up schedule after radical prostatectomy. Data presented in poster format at the American Urological Association 2018 annual meeting, San Francisco, May 18–21. Abstract MP05-06.