Prostate Specific Antigen Testing after Radical Prostatectomy-Can We Stop at 20 Years?

Wesley W Ludwig; Zhaoyong Feng; Bruce J Trock; Elizabeth Humphreys; Patrick C Walsh

doi:10.1016/j.juro.2017.08.041

Prostate Specific Antigen Testing after Radical Prostatectomy-Can We Stop at 20 Years?

J Urol. 2018 Jan;199(1):114-119. doi: 10.1016/j.juro.2017.08.041. Epub 2017 Aug 14.

Authors

Wesley W Ludwig¹, Zhaoyong Feng², Bruce J Trock², Elizabeth Humphreys², Patrick C Walsh²

Affiliations

¹ The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: wludwig1@jhmi.edu.
² The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

PMID: 28818527
DOI: 10.1016/j.juro.2017.08.041

Abstract

Purpose: We examined the clinical features and outcomes associated with delayed biochemical recurrence after radical prostatectomy, specifically among men with more than 20 years of followup.

Materials and methods: A total of 16,720 men underwent radical prostatectomy and 2,699 experienced biochemical recurrence. We determined predictors of delayed biochemical recurrence as well as metastasis-free and cancer specific survival rates for recurrence at various time points after radical prostatectomy. We performed subset analysis of the 732 men with 20 or more years of recurrence-free followup. Cumulative incidence curves for metastasis and prostate cancer death were calculated and stratified by biochemical recurrence time points.

Results: Predictors of delayed biochemical recurrence included elevated prostate specific antigen at radical prostatectomy, higher clinical and pathological stage, and positive surgical margins. Delayed biochemical recurrence was associated with favorable cumulative incidence curves for metastasis and prostate cancer death compared to early biochemical recurrence. Among the 732 men with undetectable prostate specific antigen at 20 years biochemical recurrence developed in 17 (2.3%), metastatic disease developed in a single patient and none died of prostate cancer. The actuarial probability of biochemical recurrence among men with undetectable prostate specific antigen at 20 years increased with adverse pathological features.

Conclusions: Men with delayed biochemical recurrence have favorable clinical features and improved survival. Men with undetectable prostate specific antigen 20 years after radical prostatectomy had a low rate of recurrence and no deaths from prostate cancer. This suggests that 20 years is a reasonable time to discontinue prostate specific antigen testing.

Keywords: early detection of cancer; local; neoplasm recurrence; prostate-specific antigen; prostatectomy; prostatic neoplasms.

MeSH terms

Adult
Aged, 80 and over
Disease-Free Survival
Humans
Male
Middle Aged
Neoplasm Recurrence, Local / blood*
Neoplasm Recurrence, Local / pathology*
Neoplasm Staging
Prostate-Specific Antigen / blood*
Prostatectomy / methods
Prostatic Neoplasms / blood*
Prostatic Neoplasms / pathology*
Prostatic Neoplasms / surgery*
Time Factors

Substances

Prostate-Specific Antigen