Prostate-Specific Antigen as an Ultrasensitive Biomarker for Patients with Early Recurrent Prostate Cancer: How Low...

Area of Science:

• Oncology
• Biochemistry
• Medical Diagnostics

Background:

• Serum prostate-specific antigen (PSA) monitoring is essential for detecting prostate cancer (PCa) recurrence post-radical prostatectomy (RP).
• Ultrasensitive PSA assays (uPSAs) enable earlier detection of PSA recurrence (PSAR) at lower levels (<0.5 µg/L).
• Timely initiation of salvage radiotherapy (SRT) based on uPSA levels may improve patient outcomes.

Purpose of the Study:

• To systematically review and summarize the utility of ultrasensitive PSA assays (uPSAs) in managing localized prostate cancer (PCa).
• To evaluate the association between pre-recurrence PSA levels and subsequent PSA recurrence (PSAR) and survival.
• To inform clinical decisions regarding salvage radiotherapy (SRT) timing based on uPSA monitoring.

Main Methods:

• Systematic review of studies on uPSAs for localized PCa, registered as InPLASY2023110084.
• Searched Google Scholar, PUBMED, and reference lists; included English-language studies on uPSAs.
• Analyzed data from 115 studies involving 67,479 patients, focusing on PSA assay methods and clinical findings.

Main Results:

• Extremely low post-surgery PSA nadir and early PSA changes effectively differentiated patients prone to PSAR.
• Patients with the lowest post-surgery PSA nadir and lowest PSA at SRT exhibited reduced mortality.
• A rising, yet still very low, PSA level at SRT initiation was linked to favorable 5-year overall survival.

Conclusions:

• Pre-recurrence PSA levels, detected by uPSAs, are strongly associated with future PSAR and survival in localized PCa patients.
• uPSAs are critical for precise monitoring and timely intervention, such as SRT.
• Optimal management of localized PCa relies on sensitive PSA monitoring to predict outcomes and guide therapy.