Monitoring disease after radical prostatectomy
This test should not be used for initial prostate cancer screening.
Prostate-specific antigen (PSA) is the most widely used method to detect prostate cancer recurrence after radical prostatectomy (RP). Approximately 20% to 35% of patients develop a rising PSA following RP for clinically localized prostate cancer. Biochemical recurrence (BCR) is defined as an increase in PSA after curative therapy without clinical or radiological evidence of disease. The median time to BCR could vary between 2 to 3 years. A standard PSA cutpoint to indicate BCR has yet to be established. For example, the American Urological Association and the American Society for Radiation Oncology defined BCR after surgery as initial and confirmatory PSA concentrations of 0.2 ng/mL or greater. However, a BCR definition of 0.4 ng/mL PSA has also been proposed.
Assays that measure PSA to concentrations below 0.1 ng/mL are denoted ultrasensitive PSA (USPSA). The use of USPSA cutpoints below currently recommended PSA thresholds may be helpful in identifying cases of early biochemical recurrence and for selecting patients with adverse clinicopathologic risk factors for secondary therapy. However, some authors believe that USPSA assays offers minimal advantages and could lead to increased anxiety in patients who have clinically meaningless rises of PSA and might lead to overtreatment.
An undetectable (<0.01 ng/mL) ultrasensitive prostate-specific antigen (USPSA) concentration after radical prostatectomy is reassuring and may aid in postoperative risk stratification of patients.
A detectable USPSA concentration (> or =0.01 ng/mL) after radical prostatectomy (RP) does not necessarily translate into disease progression or recurrence. Interpretation of a detectable USPSA needs to be made in conjunction with other clinicopathologic risk factors. The cutpoint for interpretation of USPSA assays remains controversial and has ranged from 0.01 to 0.05 ng/mL. For example, in a study that included 754 men after RP, a cutpoint of 0.01 ng/mL was an independent predictor of biochemical recurrence (BCR). BCR-free survival at 5 years was 92.4% for patients with an USPSA post-RP of less than 0.01 ng/mL and 56.8% for patients with an USPSA post-RP of 0.01 ng/mL or higher.(1) In the same study a cutoff of 0.03 ng/ml also predicted BCR independent of clinicopathological factors and BCR-free survival at 5 yrs was 90.8% for patients with an USPSA post-RP of less than 0.03 ng/mL and 26.9% for patients with a PSA post-RP of greater or equal to 0.03 ng/mL.(1)
Serum markers are not specific for malignancy, and values may vary by method.
When age is not supplied, the results cannot be flagged as high or low.
Digital rectal examination generally does not increase normal prostate-specific antigen (PSA) values. However, cystoscopy, urethral instrumentation, and prostate biopsy may increase PSA levels.
Some patients who have been exposed to animal antigens, either in the environment or as part of treatment or imaging procedure, may have circulating antianimal antibodies present. These antibodies may interfere with the assay reagents to produce unreliable results.
No interference was observed from rheumatoid factors up to a concentration of 1,500 IU/mL.
There is no high-dose hook effect at total PSA concentrations up to 17,000 ng/mL.
1. 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 Feb;195(2):330-336
2. Thompson IM, Valicenti RK, Albertsen P, et al: Adjuvant and salvage radiotherapy after prostatectomy:AUA/ASTRO Guideline. J Urol 2013 Aug;190(2):441-449
3. Mir MC, Li J, Klink JC, et al: Optimal definition of biochemical recurrence after radical prostatectomy depends on pathologic risk factors: Identifying candidates for early salvage therapy. Eur Urol 2014 Aug;66(2):204-210
