Freedom From a Detectable Ultrasensitive Prostate-specific Antigen at Two Years After Radical Prostatectomy Predicts a Favorable Clinical Outcome: Analysis of the SEARCH Database

Steven L. Chang, Stephen J. Freedland, Martha K. Terris, William J. Aronson, Christopher J. Kane, Christopher Amling, Joseph C. Presti

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Abstract

Objectives: To assess the utility of kinetics for ultrasensitive prostate-specific antigen (uPSA) assays to identify men who are at risk of developing high-risk recurrent prostate cancer [prostate-specific antigen doubling time (PSADT) <9 months] after radical prostatectomy. Previous studies demonstrate that a PSADT <9 months after radical prostatectomy is associated with prostate cancer-specific mortality. Conventionally, PSADT has been calculated after biochemical failure (PSA ≥ 0.2 ng/mL). Methods: A review of the Shared Equal Access Regional Cancer Hospital database from 1988-2008 was performed to identify men with biochemical failure after radical prostatectomy and ≥ 2 uPSA values before failure (PSA ≥ 0.2 ng/mL) as well as ≥ 2 values after failure to calculate PSADT. These patients were stratified into low-risk (PSADT ≥ 9 months) and high-risk (PSADT <9 months) cohorts. The following uPSA kinetics were analyzed for their ability to predict low- and high-risk cohorts: time to first detectable uPSA, time from uPSA to biochemical failure, uPSA velocity, uPSADT, uPSA exponential rise, and uPSA fluctuations. Results: The analysis included 89 low- and 26 high-risk men. Time to first detectable uPSA was inversely associated with the high-risk cohort (OR 0.96, 95% CI 0.92-0.99, P = .02) and characterized by a high sensitivity and negative predictive value at a threshold of 2 years after surgery. Other measures of uPSA kinetics showed no association with PSADT. Conclusions: Time to first detectable uPSA identifies men with low-risk recurrence prostate cancer. Patients with an undetectable uPSA 2 years after surgery are unlikely to develop PSADT <9 months after biochemical failure.

Original languageEnglish (US)
Pages (from-to)439-444
Number of pages6
JournalUrology
Volume75
Issue number2
DOIs
StatePublished - Feb 2010

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Prostate-Specific Antigen
Prostatectomy
Databases
Prostatic Neoplasms
Cancer Care Facilities

ASJC Scopus subject areas

  • Urology

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Freedom From a Detectable Ultrasensitive Prostate-specific Antigen at Two Years After Radical Prostatectomy Predicts a Favorable Clinical Outcome : Analysis of the SEARCH Database. / Chang, Steven L.; Freedland, Stephen J.; Terris, Martha K.; Aronson, William J.; Kane, Christopher J.; Amling, Christopher; Presti, Joseph C.

In: Urology, Vol. 75, No. 2, 02.2010, p. 439-444.

Research output: Contribution to journalArticle

Chang, Steven L. ; Freedland, Stephen J. ; Terris, Martha K. ; Aronson, William J. ; Kane, Christopher J. ; Amling, Christopher ; Presti, Joseph C. / Freedom From a Detectable Ultrasensitive Prostate-specific Antigen at Two Years After Radical Prostatectomy Predicts a Favorable Clinical Outcome : Analysis of the SEARCH Database. In: Urology. 2010 ; Vol. 75, No. 2. pp. 439-444.
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abstract = "Objectives: To assess the utility of kinetics for ultrasensitive prostate-specific antigen (uPSA) assays to identify men who are at risk of developing high-risk recurrent prostate cancer [prostate-specific antigen doubling time (PSADT) <9 months] after radical prostatectomy. Previous studies demonstrate that a PSADT <9 months after radical prostatectomy is associated with prostate cancer-specific mortality. Conventionally, PSADT has been calculated after biochemical failure (PSA ≥ 0.2 ng/mL). Methods: A review of the Shared Equal Access Regional Cancer Hospital database from 1988-2008 was performed to identify men with biochemical failure after radical prostatectomy and ≥ 2 uPSA values before failure (PSA ≥ 0.2 ng/mL) as well as ≥ 2 values after failure to calculate PSADT. These patients were stratified into low-risk (PSADT ≥ 9 months) and high-risk (PSADT <9 months) cohorts. The following uPSA kinetics were analyzed for their ability to predict low- and high-risk cohorts: time to first detectable uPSA, time from uPSA to biochemical failure, uPSA velocity, uPSADT, uPSA exponential rise, and uPSA fluctuations. Results: The analysis included 89 low- and 26 high-risk men. Time to first detectable uPSA was inversely associated with the high-risk cohort (OR 0.96, 95{\%} CI 0.92-0.99, P = .02) and characterized by a high sensitivity and negative predictive value at a threshold of 2 years after surgery. Other measures of uPSA kinetics showed no association with PSADT. Conclusions: Time to first detectable uPSA identifies men with low-risk recurrence prostate cancer. Patients with an undetectable uPSA 2 years after surgery are unlikely to develop PSADT <9 months after biochemical failure.",
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AU - Chang, Steven L.

AU - Freedland, Stephen J.

AU - Terris, Martha K.

AU - Aronson, William J.

AU - Kane, Christopher J.

AU - Amling, Christopher

AU - Presti, Joseph C.

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AB - Objectives: To assess the utility of kinetics for ultrasensitive prostate-specific antigen (uPSA) assays to identify men who are at risk of developing high-risk recurrent prostate cancer [prostate-specific antigen doubling time (PSADT) <9 months] after radical prostatectomy. Previous studies demonstrate that a PSADT <9 months after radical prostatectomy is associated with prostate cancer-specific mortality. Conventionally, PSADT has been calculated after biochemical failure (PSA ≥ 0.2 ng/mL). Methods: A review of the Shared Equal Access Regional Cancer Hospital database from 1988-2008 was performed to identify men with biochemical failure after radical prostatectomy and ≥ 2 uPSA values before failure (PSA ≥ 0.2 ng/mL) as well as ≥ 2 values after failure to calculate PSADT. These patients were stratified into low-risk (PSADT ≥ 9 months) and high-risk (PSADT <9 months) cohorts. The following uPSA kinetics were analyzed for their ability to predict low- and high-risk cohorts: time to first detectable uPSA, time from uPSA to biochemical failure, uPSA velocity, uPSADT, uPSA exponential rise, and uPSA fluctuations. Results: The analysis included 89 low- and 26 high-risk men. Time to first detectable uPSA was inversely associated with the high-risk cohort (OR 0.96, 95% CI 0.92-0.99, P = .02) and characterized by a high sensitivity and negative predictive value at a threshold of 2 years after surgery. Other measures of uPSA kinetics showed no association with PSADT. Conclusions: Time to first detectable uPSA identifies men with low-risk recurrence prostate cancer. Patients with an undetectable uPSA 2 years after surgery are unlikely to develop PSADT <9 months after biochemical failure.

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