Prostate news article, March 2005
| WHAT TO EXPECT
WHEN PSA REMAINS DETECTABLE AFTER RADICAL PROSTATECTOMY
Rogers CG, Khan MA, Miller MC, Veltri RW, Partin AW. Natural history of disease progression in patients who fail to achieve an undetectable PSA level after undergoing radical prostatectomy. Article in Cancer 2004; 101:2549-56. Reviewed by: Dr Charlotte Foley MA BMBCh MRCS |
There is a paucity of knowledge about the prospects of patients whose PSA remains persistently detectable (being at least 0.1ng/dl) at 6 weeks after radical retropubic prostatectomy. Now Dr. Alan Partin and colleagues have studied the disease progress of 160 such patients.
Recordable PSA levels imply either previously undiagnosed deposits of cancer elsewhere in the body (metastases) or the presence of residual (cancerous or benign) tissue in the prostate bed. Patients with a persistently recordable PSA, run a risk of developing metastases of 32% at 3 years, 51% at 5 years and 78% at 10. It is clear though that some men remain metastasis free for many years while others experience rapid disease progression.
Two main predictors emerged. Men whose prostatectomy specimen cancers had a Gleason score (a marker of aggressiveness) of less than 8 were 62% likely to remain free of metastases at 5 years, compared to a 32% chance for those with Gleason 8 or more cancers. Better still, those whose rate of rise in PSA levels was less than 0.05ng/dl, 3-12 months after the operation had a 32% likelihood of distant progression versus a 70% risk for those with greater PSA rises. This equals a median time to metastases of 3.5 years versus 13.
The authors suggested that these patients, especially when the cancer was aggressive, should be followed up closely, with 3 monthly PSA checks for the first 18 months, to ensure timely diagnosis and treatment. Predictive nomograms (such as Partin's tables) combining other variables could also be constructed for possibly even better patient discrimination.