PD03: Prostate Cancer: Epidemiology & Natural History I
PD03-09: The Natural History of a Detectable Serum PSA after Radical Prostatectomy
Friday, May 13, 2022
8:20 AM – 8:30 AM
Location: Room 245
Julie A. Szymaniak*, Samuel L. Washington III, Janet E. Cowan, Matthew R. Cooperberg, Peter E. Lonergan, Hao G. Nguyen, Peter R. Carroll, SAN FRANCISCO, CA
Introduction: Radical prostatectomy (RP) is a common form of definitive treatment for men with localized prostate cancer. A detectable postoperative serum PSA is thought to represent treatment failure and such patients are often offered salvage therapy while those with an undetectable PSA are monitored closely. We aim to better characterize the natural history of patients with a delayed detectable PSA after RP using a “ultrasensitive” cut point (0.03 ng/ml), a more contemporary value.
Methods: A retrospective analysis of men who underwent RP for non-metastatic prostate cancer at the University of California, San Francisco from 2000 to 2021, who consented for research, and had extensive follow-up was performed. Each participant in the delayed group reached an undetectable post-operative PSA within 6 months. The primary outcome was biochemical recurrence, defined as 2 consecutive PSA>=0.03 starting 6 months after surgery. Secondary outcomes were salvage treatment, post-salvage treatment, metastasis (nodal or bone) free survival (MFS), prostate cancer specific mortality (PCSM), and all-cause mortality (ACM).
Results: From our cohort of 3132 patients, we identified 2684 men who had an undetectable post-op PSA. The median follow-up after RP was 55 months. Subsequently, 646 men had a delayed detectable PSA at a median time of 29 months (IQR 16, 54). PSA at time of failure was <0.1 for 63.9% of men, 0.1-0.2 for 19.8%, and >0.2 for 16.1%. Of those with a delayed detectable PSA, 42% underwent salvage treatment within 10 years after RP. PSA at diagnosis (HR 1.02, CI 1.01-1.03, p=0.003), high Decipher score (HR 1.56, CI 1.02-2.38, p=0.04), and surgical CAPRA-S (HR 1.13, CI 1.06-1.2, p=0.0003) were associated with risk of receiving salvage treatment. In terms of treatment type, 95% received radiation +/- ADT, 4.4% received ADT alone, and 0.4% had advanced treatment. After salvage treatment, 63% of men had recurrent PSA failure within 10 years. In this subcohort, 20% had radiation, 76% received hormonal therapy, and 3.3% had advanced treatment. Overall, MFS was 95%, PCSM 2%, and ACM 5% at 10 years. For those with recurrent PSA failure after salvage treatment, MFS was 70%, PCSM 22% and ACM 22% at 10 years' time.
Conclusions: Men who develop a detectable serum PSA >6 months post-operatively may have excellent long-term outcomes. Such information can be used to assess the timing and type of additional treatment.
Source of Funding: Goldberg-Benioff Program in Translational Cancer Biology in the UCSF Department of Urology