Authors say PSA level should be assessed for at least three months after radical prostatectomy for prostate cancer to accurately document persistent PSA
THURSDAY, March 27, 2025 (HealthDay News) — Assessment of prostate-specific antigen (PSA) level for three months after radical prostatectomy (RP) for prostate cancer may minimize overtreatment, according to a study published online March 13 in JAMA Oncology.
Derya Tilki, M.D., from University Hospital Hamburg Eppendorf in Germany, and colleagues examined the time necessary to accurately document a persistent PSA level after RP in a cohort study. The study included patients with T1N0M0 to T3N0M0 prostate cancer treated with RP between 1992 and 2020 at two academic centers. The discovery cohort included 30,461 patients, and the validation cohort included 12,837 patients.
The researchers found that for patients with persistent versus undetectable PSA, a pre-RP PSA level >20 ng/mL versus ≤20 ng/mL was significantly associated with reduced all-cause mortality (ACM) risk and prostate cancer-specific mortality (PCSM) risk (adjusted hazard ratios, 0.69 and 0.41, respectively). These findings persisted after adjustment for prostate volume and were confirmed in the validation cohort for PCSM risk. In patients with a pre-RP PSA >20 ng/mL versus ≤20 ng/mL, there was more frequent and a shorter median time to post-RP radiation therapy plus androgen deprivation therapy (ADT) or ADT use (54.7 percent at a median of 2.68 months versus 34.8 percent at a median of 3.30 months). These treatment times were shorter than those to an undetectable PSA in observed patients (median, 2.96 versus 3.37 months). There was an association seen for increasing persistent PSA level with increased ACM and PSCM risks (adjusted hazard ratios, 1.14 and 1.27, respectively).
“The clinical significance of these findings is that they highlight the need to monitor PSA after RP for longer than the commonly practiced 1.5-month to 2.0-month interval before concluding a persistent PSA exists and initiating post-RP therapy to minimize the risk of overtreatment,” the authors write.
One author disclosed ties to the biopharmaceutical industry.
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