This interesting research came today. It's a study from UCLA that looks at the predictive value of early ultra-sensitive PSA scores in a group of men who had prostatectomy as their initial treatment, were found to have organ-contained cancer, and who then had a recurrrence, an average of 4-5 years later. The question they were investigating is whether an ultrasensitive psa reading gave a better indicator of who would recur and how quickly, as compared to the conventional standard of recurrence of PSA>.2 . So this fits into the debate frequently surfacing in these pages about
the whether one should monitor with the ultrasensitive test (thereby facing a lot of anxiety over small movements) or stick with the conventional test (thereby avoiding anxiety, but not jumping on a recurrence as quickly.)
In essence, the research says that people whose initial psa after surgery is >.03 were much more likely to have a relapse and to have it sooner. The authors also propose that .03 should replace .2 as the definition of biochemical recurrence. They point out that if such a change were made, salvage therapy would begin an average of 33 months sooner, giving it a greater chance of working. Of course, this will be very controversial.
The research also found that those with rising PSA and negative margins are more likely to go on to have a relapse (defined the conventional way as PSA>0.2) and are likely to have it sooner. So if you have the combination of a rising PSA on ultrasensitive measure, and an initial post surgical psa of 0.03 or higher, you might not want to wait for it to hit 0.2 before acting. YMMV.
(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
April 30, 2015 | ARS 2015
Jung Julie Kang, MD, PhD, Robert Reiter, MD, Patrick Kupelian, MD, Michael Steinberg, MD, Christopher R. King, PhD, MD; Department of Radiation Oncology, Department of Urology, UCLA
PURPOSE/OBJECTIVES: Randomized controlled trials have shown that adjuvant radiotherapy (RT) after radical prostatectomy (RP) improves biochemical relapse-free and overall survival in patients with extracapsular disease. However, even patients with organ-confined disease are at risk for failure. This study analyzes postoperative (postop) ultrasensitive prostate-specific antigen (uPSA) in the surveillance of these patients.
MATERIALS AND METHODS: From 1991–2013, 146 patients with pT2N0 disease who were referred for a rise in PSA after RP were identified: 85 were margin-positive (m+), and 61 were margin-negative (m−). Surgical approach (
open vs robotic), initial PSA (iPSA), Gleason grade, margin status, and postop uPSA were covariates for analysis. Median first postop PSA and follow-up were 3 and 38 months, respectively. The uPSA threshold was 0.01 ng/mL.
Benign uPSA patterns occurred from 0.01–0.02 ng/mL; thus, ≥ 0.03 ng/mL was defined as uPSA failure. True (conventional) biochemical relapse (tBCR) was defined as PSA ≥ 0.2 ng/mL. Patients were censored at last follow-up or adjuvant therapy. Kaplan-Meier and Cox multivariate analyses were used to compare tBCR rates.
RESULTS: Median time to tBCR for the entire cohort was 50 months. The m+ patients revealed a more indolent course than m− patients (median time to relapse: 86 mo for m+ vs 33 mo for m−; P = .0003). No differences in Gleason grade or iPSA between m+ and m− patients were seen.
On multivariate analysis (MVA), only first postop uPSA ≥ 0.03 ng/mL (hazard ratio [HR] = 4.1; P < .001) and margin status (m−: HR = 5.6; P = .0315) independently predicted for time to tBCR.
First postop uPSA ≥ 0.03 ng/mL discerned tBCR with much greater sensitivity than undetectable first conventional PSA < 0.2 ng/mL (44% vs 19%). First postop uPSA < 0.03 ng/mL vs. ≥ 0.03 ng/mL predicted median tBCR at 61 vs 10 months (P = .0003). Any postop uPSA ≥ 0.03 ng/mL captured all failures missed by analyzing only the first postop value (100% sensitivity).
Using uPSA ≥ 0.03 ng/mL to identify relapse yields a substantial (33 mo) lead time advantage over waiting until conventional relapse at PSA ≥ 0.2 ng/mL (median 17 vs 50 mo in favor of uPSA ≥ 0.03 ng/mL).
CONCLUSIONS: Only first postop uPSA ≥ 0.03 ng/mL and margin status independently predicted biochemical relapse for organ-confined prostate cancer. The m− patients exhibited much earlier failures, suggesting greater biologic aggressiveness.Biochemical failure can be called at uPSA ≥ 0.03 ng/mL with excellent sensitivity, and adopting it offers an impressive lead time advantage over the conventional failure definition (PSA ≥ 0.2 ng/mL).
Integrating uPSA into the immediate and continued frequent surveillance of RP patients with organ-confined cancer will improve postop RT outcomes by identifying failures sooner and promoting an early salvage strategy.
Proceedings of the 97th Annual Meeting of the American Radium Society —
- See more at: http://www.cancernetwork.com/ars-2015/ultrasensitive-psa-identifies-patients-organ-confined-prostate-cancer-requiring-postop-rt
Post Edited (proscapt) : 5/1/2015 11:22:51 PM (GMT-6)