Evaluating the association between the lowest PSA value after prostate surgery and the occurrence of biochemical recurrence in patients with localized prostate cancer

This study investigated the association between the lowest PSA value after radical prostatectomy (RP; surgery to remove the prostate) and the occurrence of biochemical recurrence (BCR) in patients with localized prostate cancer (PCa). The study found that a higher PSA value after RP and a shorter time to reach this value could predict the risk of BCR in these patients.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland.Men with PCa usually have high levels of prostate-specific antigen (PSA). PSA is a protein made by the cells of the prostate gland. PCa can be treated by surgery, radiation, or hormone therapy. PSA levels usually go down after successful treatment for PCa.

Radical prostatectomy (RP) surgically removes the prostate and the surrounding tissues in patients with PCa. Almost 15-40% of men who undergo RP as a treatment for PCa experience biochemical recurrence (BCR). BCR means an increase by 0.2 ng/mL from the lowest value of the PSA. However, there are very few studies investigating the association between the lowest PSA value after RP and the occurrence of BCR in patients with PCa.

This study involved 1483 patients with PCa. All the patients had a PSA lowest value of less than 0.2ng/mL and had no cancer cells left behind at the tumor site following RP. 323 patients had BCR after RP (BCR group). 1160 patients did not have BCR after RP (non-BCR group). The average follow-up time was 109 months for the BCR group and 86 months for the non-BCR group.

The average PSA level before surgery was 9.75 ng/mL for the BCR group and 6.71 ng/mL for the non-BCR group. After treatment, the average time to reach the lowest PSA value in the BCR group was 4.64 months compared to 7.43 months in the non-BCR group. The average lowest PSA value was 0.035 ng/mL in the BCR group and 0.014 ng/mL in the non-BCR group.

The occurrence of BCR was significantly higher in patients who had a higher lowest PSA value. Advanced cancer stage, high tumor volume, and open surgery were also associated with BCR.

This study concluded that a high PSA lowest value after RP and a shorter time to reach this value increased the risk of BCR in patients with PCa.

The study looked back in time at medical records and the follow-up period after RP was not uniform. Patients did not receive hormonal therapy. Also, treatments after BCR were not evaluated.