Can we stop prostate specific antigen testing 10 years after radical prostatectomy?

Area of Science:

• Urology
• Oncology
• Prostate Cancer Research

Background:

• Biochemical recurrence risk after radical prostatectomy is linked to relapse-free interval.
• Predictors of late recurrence and survival outcomes require further investigation.

Purpose of the Study:

• To identify predictors of late biochemical recurrence (>10 years post-radical prostatectomy).
• To analyze the relationship between timing of biochemical recurrence and long-term survival.

Main Methods:

• Analysis of 10,609 men treated with radical prostatectomy, focusing on 1,684 with biochemical recurrence.
• Calculation of metastasis-free and cancer-specific survival rates from recurrence time.
• Assessment of survival in a subset with undetectable PSA at 10 years.

Main Results:

• Late recurrence (>10 years) associated with better pathological features and survival.
• For men with undetectable PSA at 10 years, recurrence and metastasis probabilities at 20 years varied by stage/grade.
• No metastases observed in patients with Gleason score ≤6 at 20 years post-prostatectomy.

Conclusions:

• Men with undetectable PSA >10 years post-prostatectomy have low subsequent recurrence, metastasis, and mortality risks.
• Counseling on low cancer-related morbidity and mortality risk is warranted for these patients.
• Annual PSA testing may be safely discontinued after 10 years for select patients (Gleason score ≤6, limited life expectancy).