Opportunities for Quality Improvement in Postoperative Prostate-Specific Antigen Testing After Radical Prostatectomy

After radical prostatectomy (RP), PSA testing is performed to identify persistent or recurrent prostate cancer. We explored the timing and results of initial PSA testing after RP.

Patients undergoing RP within the Michigan Urological Surgery Improvement Collaborative from March 2012 to December 2023 were included. Timing and detectable value of initial and confirmatory PSA testing were measured.

Of 21,991 patients, 81.9% had an initial PSA < 90 days of surgery, 9.9% had initial PSA within 91 to 120 days, 6.2% had initial PSA > 120 days, and 2.0% had no available postoperative PSA. Two thousand two hundred ninety-two of 18,021 patients (17.6%) with PSA < 90 days had an initial value > 0.1 ng/mL, of whom 20% had no confirmatory PSA within 6 months. Four hundred fifty-two patients (2.1%) had PSA < 3 weeks of RP, of which 77% were > 0.1 ng/mL, and repeat PSA testing remained > 0.1 ng/mL in only 21%. Two thousand eight hundred twenty-nine patients (12.9%) tested PSA 3 to 5 weeks after RP, with 15% > 0.1 ng/mL and 52% remained > 0.1 ng/mL. By contrast, only 10% of PSA values obtained > 5 weeks were > 0.1 ng/mL, and 80% remained > 0.1 ng/mL on repeat testing.

Initial PSA testing < 5 weeks after RP provides unclear results, with false-positive detectable results that often become undetectable when repeated. Alternatively, repeat PSA testing confirmed detectable PSA in 80% of patients whose initial PSA was 35 to 90 days after RP. Opportunities for education and quality improvement include (1) initial PSA testing is best performed > 5 weeks and < 90 days after surgery and (2) timely confirmatory PSA testing is required when the initial PSA is detectable.