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Updated: Aug 21, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Optimal prostate-specific antigen thresholds for early salvage therapy after robotic-assisted radical prostatectomy
Jong Hoon Lee1, Chung Un Lee2, Wan Song1
1Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Purpose:
Biochemical recurrence (BCR) after radical prostatectomy is defined as prostate-specific antigen (PSA) >0.2 ng/ml with a subsequent increase. However, early salvage therapy at lower PSA levels may improve outcomes. We aimed to evaluate optimal PSA thresholds for predicting BCR after robotic-assisted radical prostatectomy.
Methods:
We retrospectively analyzed 595 patients who underwent robotic-assisted radical prostatectomy by a single surgeon between 2015 and 2019, excluding those with positive lymph nodes. PSA persistence was defined based on the first postoperative PSA measurement at 1 month. BCR was defined as PSA >0.2 ng/ml with a subsequent increase. Patients were stratified into 3 groups: PSA ≥0.03, ≥0.05, and ≥0.1 ng/ml, with a subsequent increase. Kaplan-Meier analysis was used to assess BCR-free survival, with subgroup analysis stratified by the Cancer of the Prostate Risk Assessment-Surgical classification.
Results:
Median follow-up was 4.8 (interquartile range [IQR] 4.2-5.7) years. PSA ≥0.03, ≥0.05, and ≥0.1 ng/ml exhibited a 5-year BCR-free survival of 63.8%, 34.8%, and 0.0%, respectively, and a median time (IQR) of 0.3 (0.2-0.7), 0.8 (0.3-1.7), and 1.6 (0.7-2.8) years. The median time to recurrence was not reached in the PSA ≥0.03 ng/ml group, whereas it was 1.9 (IQR 1.6-2.3) and 0.7 (IQR 0.5-0.8) years for those with PSA ≥0.05 and ≥0.1 ng/ml, respectively. High-risk patients with PSA ≥0.03 ng/ml had significantly shorter survival than did others (median 1.1 years; 5-year rate 17.3%). Notably, the generalizability of these results is limited by the study's retrospective nature.
Conclusions:
BCR occurred in approximately 1 year in patients with PSA ≥0.1 ng/ml and high-risk patients with PSA ≥0.03 ng/ml. Our findings demonstrate that a lower PSA threshold of 0.03 ng/ml effectively sub-stratifies patients at risk for early recurrence. Therefore, early salvage therapy should be considered at lower PSA levels than the conventional definition, particularly for high-risk patients.