Detectable Prostate-specific antigen value between 0.01 and 0.1 ng/ml following robotic-assisted radical...

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Robot-assisted radical prostatectomy (RARP) is a common treatment for prostate cancer.
• Post-surgical monitoring of prostate-specific antigen (PSA) is crucial for detecting recurrence.
• Ultrasensitive PSA (uPSA) assays offer improved detection sensitivity for residual or recurrent disease.

Purpose of the Study:

• To evaluate the impact of a persistently detectable ultrasensitive prostate-specific antigen (uPSA) between 0.01 and 0.1 ng/ml after RARP on future biochemical recurrence (BCR).
• To identify predictive markers for BCR in patients with minimal detectable PSA levels post-surgery.

Main Methods:

• Retrospective analysis of 1359 men undergoing RARP (2006-2019) with prospectively maintained data.
• Patients monitored with uPSA at serial time points post-surgery.
• Inclusion criteria: uPSA nadir 0.01-0.1 ng/ml within 6 months and ≥2 follow-up measurements in this range.
• Multivariable Cox regression models used to predict BCR-free survival (BCR-FS).

Main Results:

• 167 patients (12.3%) met inclusion criteria; mean follow-up 60.2 months.
• 5-year BCR-FS rate was 86%; 19.1% of patients experienced BCR.
• BCR-free patients maintained uPSA ≤0.033 ng/ml; BCR patients showed a rising trend starting at 9 months (p<0.02).
• Rising uPSA from 9 months post-RARP independently predicted BCR (HR: 2.7; p=0.013).

Conclusions:

• A significant proportion of men exhibit detectable uPSA (0.01-0.1 ng/ml) post-RARP.
• A rising uPSA trend from 9 months is an independent predictor of BCR.
• Regular monitoring of these patients is recommended to manage anxiety and inform timely salvage radiotherapy.