PSA levels can predict disease progression following prostate removal

This study evaluated the outcomes of prostate cancer patients with persistently detectable levels of prostate-specific antigen (PSA) following radical prostatectomy (RP).

Radical prostatectomy or RP (surgical removal of the prostate gland and some tissue around it) is a common treatment for patients with prostate cancer. Following RP, the level of PSA (a protein produced by the prostate gland whose levels rise in prostate cancer) should be undetectable. If PSA levels are still detected in the blood, it is assumed that the cancer has returned or had spread to other areas, and it is a negative predictor for disease progression. However, the outcomes of patients whose PSA levels are still detectable following RP have not been fully researched. The current study examined the association between detectable PSA levels following RP and disease progression.

496 prostate cancer patients who had detectable PSA levels following RP were included in this study. PSA levels were measured every 3 months in the first year following RP, every 6 months in the second year, and annually afterwards. Detectable PSA was defined as values of 0.1 ng/ml or greater 6 weeks after surgery and progressive disease was defined after two PSA measurements of more than 0.2 ng/ml 3 months following RP.

PSA levels 6 weeks after RP were 0.1 to 6.8 ng/ml, and disease progression was found in 74.4% of patients. 68.9% of patients underwent one salvage treatment (treatment following initial therapy for prostate cancer, such as radiotherapy), while 13.9% needed therapy beyond the first salvage treatment (general treatments such as long-term hormonal therapy). Patients with PSA levels greater than 1 ng/ml following RP were 3.46 times more likely to require general treatments than patients with lower PSA levels. Patients whose PSA levels rose with 0.2 ng/ml or more per year (PSA velocity) were 6 times more likely to require general treatments than patients with slower progression. A high PSA velocity was associated with a 58.4% five-year survival rate compared to 81% in patients with stable or negative PSA velocity.

In summary, PSA persistence and PSA velocity following radical prostatectomy are both negative predictors of disease progression and poorer outcomes. Thus, there is need for more aggressive treatments for these patients.

Consult with your physician regarding the appropriate treatment for your situation.