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

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Prostate-specific antigen (PSA) testing is standard for monitoring prostate cancer after radical prostatectomy (RP).
• Determining the optimal timing for initial and subsequent PSA tests is essential for accurate detection of persistent or recurrent disease.

Purpose of the Study:

• To investigate the impact of timing on initial PSA test results after RP.
• To evaluate the reliability of confirmatory PSA testing based on initial results and timing.

Main Methods:

• Retrospective analysis of 21,991 patients who underwent RP between March 2012 and December 2023.
• Measurement of the timing and detectable values of initial and confirmatory PSA tests post-surgery.

Main Results:

• 81.9% of patients had initial PSA tests within 90 days of RP.
• Initial PSA tests within 5 weeks of RP showed a high rate of detectable results (77% > 0.1 ng/mL), with many becoming undetectable upon repeat testing.
• PSA tests performed between 35 and 90 days post-RP had 15% detectable results, with 52% remaining detectable on repeat testing, and 80% of persistently detectable results confirmed on repeat testing.

Conclusions:

• Initial PSA testing should ideally be performed between 5 weeks and 90 days after RP for more reliable results.
• Timely confirmatory PSA testing is necessary for patients with detectable initial PSA levels to confirm recurrence accurately.