Prostate Specific Antigen Nadir After Radical Cystoprostatectomy in Patients With Benign Prostatic Tissue: A Benchmark To Define Biochemical Recurrence after Radical Prostatectomy
Urology Journal,
Vol. 16 No. 06 (2019),
24 December 2019
,
Page 563-566
https://doi.org/10.22037/uj.v16i06.4551
Abstract
Purpose: Biochemical failure after radical prostatectomy has been defined based on retrospective studies in men who underwent RP for localized prostate cancer. Nevertheless, retrospective strategy and possibility of extra-prostatic extension overshadowed the accurateness of the aforementioned cut-off value. To define a more precise PSA nadir value, we estimated serum PSA after cystoprostatectomy in cases with bladder urothelial cancer and no evidence of prostate cancer.
Materials and Methods: Study population consists of 52 subsequent patients who underwent radical cystoprostatectomy for muscle-invasive bladder cancer between December 2010 and December 2013. Patients with prostate adenocarcinoma and/or high grade prostate intraepithelial neoplasia were excluded from enrollment. Other exclusion criteria were prostate involvement with urothelial carcinoma, neoadjuvant or adjuvant chemotherapy and radiation therapy. Between all cases, 41 were enrolled for study. Serum PSA level was measured using immunochemiluminescence method among 6 months to 3 years after operation in study participants.
Results: Forty-one patients with mean age of 66.4 ± 8.9 were assessed in this study. Average serum PSA level after radical cysto-prostatectomy was .037 ± .031 ng/mL (from .002 to .1). Serum PSA level was not impressed with type of diversion or interval between operation and PSA measurement. Average serum PSA level in this study was meaningfully lesser than .2 ng/mL which is contemplated as PSA nadir value after RP.
Conclusion: Serum PSA level of 0.2 ng/mL as the definition for biochemical recurrence after RP may delay salvage treatment. Our results showed that cut off value of ?0.1 ng/mL may be more precise in the era of early salvage treatment.
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References
MOUL JW. Prostate specific antigen only progression of prostate cancer. J urol. 2000;163(6):1632-1642.
Boorjian SA, Thompson RH, Tollefson MK, et al. Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: the impact of time from surgery to recurrence. Eur urol. 2011;59(6):893-899.
Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. Jama. 1999;281(17):1591-1597.
Amling CL, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point? J urol. 2001;165(4):1146-1151.
Stephenson AJ, Kattan MW, Eastham JA, et al. Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. J Clin Oncol. 2006;24(24):3973-3978.
Buti S, Ciccarese C, Iacovelli R, et al. Inside the 2016 American Society of Clinical Oncology Genitourinary Cancers Symposium: part 2–prostate and bladder cancer. Future Medicine; 2016.
Mohler JL, Armstrong AJ, Bahnson RR, et al. Prostate cancer, version 1.2016. J Natl Compr Canc Netw. 2016;14(1):19-30.
Amling CL, Blute ML, Bergstralh EJ, Seay TM, Slezak J, Zincke H. Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: continued risk of biochemical failure after 5 years. J urol. 2000;164(1):101-105.
Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J urol. 2002;167(2):528-534.
Roehl KA, Han M, Ramos CG, Antenor JAV, Catalona WJ. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J urol. 2004;172(3):910-914.
Simforoosh N, Dadpour M, Mofid B. Cytoreductive and Palliative Radical Prostatectomy, Extended Lymphadenectomy and Bilateral Orchiectomy in Advanced Prostate Cancer with Oligo and Widespread Bone Metastases: Result of a Feasibility, Our Initial Experience. Urol J. 2018.
Diamandis E, Yu H. Prostate-specific antigen and lack of specificity for prostate cells. Lancet. 1995;345(8958):1186.
Sokoll LJ, Zhang Z, Chan DW, et al. Do ultrasensitive prostate specific antigen measurements have a role in predicting long-term biochemical recurrence-free survival in men after radical prostatectomy? J urol. 2016;195(2):330-336 .
Eisenberg ML, Davies BJ, Cooperberg MR, Cowan JE, Carroll PR. Prognostic implications of an undetectable ultrasensitive prostate-specific antigen level after radical prostatectomy. Eur urol. 2010;57(4):622-630.
Mir MC, Li J, Klink JC, Kattan MW, Klein EA, Stephenson AJ. Optimal definition of biochemical recurrence after radical prostatectomy depends on pathologic risk factors: identifying candidates for early salvage therapy. Eur urol. 2014;66(2):204-210.
Kang JJ, Reiter RE, Steinberg ML, King CR. Ultrasensitive prostate specific antigen after prostatectomy reliably identifies patients requiring postoperative radiotherapy. J urol. 2015;193(5):1532-1538.
TAYLOR III JA, Koff SG, Dauser DA, McLEOD DG. The relationship of ultrasensitive measurements of prostate‐specific antigen levels to prostate cancer recurrence after radical prostatectomy. BJU int. 2006;98(3):540-543.
Wiegel T, Bottke D, Steiner U, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009;27(18):2924-2930.
Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J urol. 2009;181(3):956-962.
Bolla M, van Poppel H, Tombal B, et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet. 2012;380(9858):2018-2027.
Kang JH, Ha Y-S, Kim S, et al. Concern for overtreatment using the AUA/ASTRO guideline on adjuvant radiotherapy after radical prostatectomy. BMC urol. 2014;14(1):30.
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