Prostate Specific Antigen Testing after Radical Prostatectomy-Can We Stop at 20 Years?

Area of Science:

• Urology
• Oncology
• Clinical Medicine

Background:

• Radical prostatectomy is a primary treatment for prostate cancer.
• Biochemical recurrence (BCR) after prostatectomy necessitates long-term monitoring.
• Understanding delayed BCR is crucial for optimizing patient follow-up strategies.

Purpose of the Study:

• To investigate clinical features and outcomes of delayed BCR after radical prostatectomy.
• To identify predictors of delayed BCR.
• To evaluate metastasis-free and cancer-specific survival rates in relation to BCR timing.

Main Methods:

• Analysis of 16,720 men undergoing radical prostatectomy, with 2,699 experiencing BCR.
• Subset analysis of 732 men with ≥20 years of recurrence-free follow-up.
• Calculation of cumulative incidence curves for metastasis and prostate cancer death stratified by BCR time points.

Main Results:

• Predictors of delayed BCR include elevated PSA at surgery, higher stage, and positive margins.
• Delayed BCR demonstrated more favorable metastasis and cancer-specific survival curves than early BCR.
• Among men with undetectable PSA at 20 years, only 2.3% had BCR, with one metastasis and zero prostate cancer deaths.

Conclusions:

• Delayed BCR is associated with favorable clinical characteristics and improved survival outcomes.
• Undetectable PSA levels at 20 years post-radical prostatectomy correlate with very low recurrence risk and no cancer mortality.
• Discontinuing prostate specific antigen (PSA) testing at the 20-year mark may be a reasonable strategy for select patients.