The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy
Abstract Objectives To assess the role of ultrasensitive PSA values (usPSA) after radical prostatectomy in predicting the subsequent biochemical recurrence (BCR). Material and methods The study included 1836 patients who underwent open or robot‐assisted RP at Turku University Hospital between 2003 a...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-11-01
|
| Series: | BJUI Compass |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/bco2.413 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832592017004167168 |
|---|---|
| author | Heikki Seikkula Jaakko Hyysalo Mikael Högerman Peter J. Boström Otto Ettala |
| author_facet | Heikki Seikkula Jaakko Hyysalo Mikael Högerman Peter J. Boström Otto Ettala |
| author_sort | Heikki Seikkula |
| collection | DOAJ |
| description | Abstract Objectives To assess the role of ultrasensitive PSA values (usPSA) after radical prostatectomy in predicting the subsequent biochemical recurrence (BCR). Material and methods The study included 1836 patients who underwent open or robot‐assisted RP at Turku University Hospital between 2003 and 2018. Exclusion criteria involved patients with adjuvant treatments and those who did not reach a PSA nadir <0.1 ng/ml, resulting in a final cohort of 1313 patients. The prognostic impact of the optimal usPSA nadir cut‐off value 6 months after RP was investigated to predict subsequent BCR for the whole cohort (N = 1313). The optimal usPSA cut‐off value was determined for patients at 3–5 years post‐surgery (N = 806) and beyond 5 years (N = 493) of follow‐up. We used the area under the curve (AUC) calculation and the Kaplan–Meier method. Results In a cohort with a median age of 64, primarily featuring Gleason score 7 prostate cancer. uPSA nadir of 0.01 ng/ml (AUC = 0.80) at the first monitoring post‐surgery emerged as the optimal cut‐off for identifying subjects at low (80%) or high (20%) risk of BCR within the first 3 years. Beyond this period, uPSA values during the first 3 [(AUC = 0.89; 3–5 years post‐surgery) and (AUC = 0.81; beyond 5 years)] and 5 post‐surgery years (AUC = 0.85) outperformed uPSA nadir in predicting subsequent BCR. Notably, EAU‐defined high‐risk patients with low uPSA nadir maintained substantial BCR‐free survival. Conclusion In conclusion, a low usPSA predicts minimal BCR risk over the next 2–3 years post‐measurement. Patients with low usPSA can benefit from reduced post‐surgery PSA monitoring at 2‐ to 3‐year intervals without compromising outcomes. This strategic approach optimizes resource allocation in busy urological outpatient clinics, especially valuable in publicly reimbursed healthcare systems like Finland. |
| format | Article |
| id | doaj-art-9a1d3f6f81174721b5323d4637748831 |
| institution | Kabale University |
| issn | 2688-4526 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj-art-9a1d3f6f81174721b5323d46377488312025-01-22T02:21:03ZengWileyBJUI Compass2688-45262024-11-015111220122710.1002/bco2.413The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomyHeikki Seikkula0Jaakko Hyysalo1Mikael Högerman2Peter J. Boström3Otto Ettala4Department of Surgery Hospital Nova of Central Finland Jyväskylä FinlandDepartment of Urology University of Turku Turku FinlandDepartment of Urology University of Turku Turku FinlandDepartment of Urology University of Turku Turku FinlandDepartment of Urology University of Turku Turku FinlandAbstract Objectives To assess the role of ultrasensitive PSA values (usPSA) after radical prostatectomy in predicting the subsequent biochemical recurrence (BCR). Material and methods The study included 1836 patients who underwent open or robot‐assisted RP at Turku University Hospital between 2003 and 2018. Exclusion criteria involved patients with adjuvant treatments and those who did not reach a PSA nadir <0.1 ng/ml, resulting in a final cohort of 1313 patients. The prognostic impact of the optimal usPSA nadir cut‐off value 6 months after RP was investigated to predict subsequent BCR for the whole cohort (N = 1313). The optimal usPSA cut‐off value was determined for patients at 3–5 years post‐surgery (N = 806) and beyond 5 years (N = 493) of follow‐up. We used the area under the curve (AUC) calculation and the Kaplan–Meier method. Results In a cohort with a median age of 64, primarily featuring Gleason score 7 prostate cancer. uPSA nadir of 0.01 ng/ml (AUC = 0.80) at the first monitoring post‐surgery emerged as the optimal cut‐off for identifying subjects at low (80%) or high (20%) risk of BCR within the first 3 years. Beyond this period, uPSA values during the first 3 [(AUC = 0.89; 3–5 years post‐surgery) and (AUC = 0.81; beyond 5 years)] and 5 post‐surgery years (AUC = 0.85) outperformed uPSA nadir in predicting subsequent BCR. Notably, EAU‐defined high‐risk patients with low uPSA nadir maintained substantial BCR‐free survival. Conclusion In conclusion, a low usPSA predicts minimal BCR risk over the next 2–3 years post‐measurement. Patients with low usPSA can benefit from reduced post‐surgery PSA monitoring at 2‐ to 3‐year intervals without compromising outcomes. This strategic approach optimizes resource allocation in busy urological outpatient clinics, especially valuable in publicly reimbursed healthcare systems like Finland.https://doi.org/10.1002/bco2.413biochemical recurrenceprostate‐specific antigenprostatic neoplasmsradical prostatectomyultrasensitive prostate‐specific antigen |
| spellingShingle | Heikki Seikkula Jaakko Hyysalo Mikael Högerman Peter J. Boström Otto Ettala The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy BJUI Compass biochemical recurrence prostate‐specific antigen prostatic neoplasms radical prostatectomy ultrasensitive prostate‐specific antigen |
| title | The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy |
| title_full | The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy |
| title_fullStr | The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy |
| title_full_unstemmed | The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy |
| title_short | The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy |
| title_sort | accuracy of ultrasensitive psa in predicting disease progression after radical prostatectomy |
| topic | biochemical recurrence prostate‐specific antigen prostatic neoplasms radical prostatectomy ultrasensitive prostate‐specific antigen |
| url | https://doi.org/10.1002/bco2.413 |
| work_keys_str_mv | AT heikkiseikkula theaccuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT jaakkohyysalo theaccuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT mikaelhogerman theaccuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT peterjbostrom theaccuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT ottoettala theaccuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT heikkiseikkula accuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT jaakkohyysalo accuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT mikaelhogerman accuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT peterjbostrom accuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy AT ottoettala accuracyofultrasensitivepsainpredictingdiseaseprogressionafterradicalprostatectomy |