Abstract
Simple SummaryRadical prostatectomy, the standard treatment for localized or locally advanced prostate cancer, generally provides good disease control and favorable long-term survival. However, about 40% of patients experience biochemical recurrence, and a significant number of them develop clinical progression. If identified in advance, those patients could receive specially tailored follow-up and counseling. Current guidelines recommend the first prostate-specific antigen tests three months after surgery, but prostate-specific antigen levels should be undetectable within four weeks. Early testing at 4–8 weeks after surgery could thus be useful for determining patient prognosis. We reviewed the medical literature to study persistence of prostate-specific antigens, progression of prostate cancer, and survival of patients. We found that prostate cancer was more likely to recur in patients with or without lymph nodal involvement who had prostate-specific antigen persistence at 4–8 weeks.We performed a systematic review and meta-analysis to assess the prognostic value of prostate-specific antigen (PSA) persistence 4–8 weeks after radical prostatectomy (RP) in patients with prostate cancer, using studies from Medline, Scopus, and Cochrane Library, on 10 October 2020. Studies were eligible if they compared patients with postoperative PSA persistence 4–8 weeks after RP to those without such persistence to assess the value of PSA persistence in prognosticating biochemical recurrence (BCR), disease recurrence, cancer-specific mortality (CSM), and overall mortality (OM) by multivariable analysis. Our review and analysis included nine studies published between 2008 and 2019 with 14,455 patients. Of those studies, 12.0% showed postoperative PSA persistence. PSA persistence was associated with BCR (HR: 4.44, 95% CI: 2.84–6.93), disease recurrence (HR: 3.43, 95% CI: 1.62–7.25), and CSM (HR: 2.32, 95% CI: 1.83–2.95). We omitted meta-analysis on the association of PSA persistence with OM due to an insufficient number of studies. PSA persistence was associated with disease recurrence in a sub-group of patients with pathological nodal involvement (HR: 5.90, 95% CI: 3.76–9.24). Understanding detection of PSA persistence at 4–8 weeks after RP might be useful for patient counseling, follow-up scheduling, and clinical decision-making regarding adjuvant therapies.
Highlights
In 2020, it was estimated that 191,930 patients were diagnosed with prostate cancer (PCa), and 33,330 died of that disease in the US
As only one study evaluated the association of prostate-specific antigen (PSA) persistence with overall mortality (OM), we did not perform a meta-analysis for OM after Radical prostatectomy (RP)
We found that PSA persistence was associated with biochemical recurrence (BCR), disease recurrence, and cancer-specific mortality (CSM) after RP
Summary
In 2020, it was estimated that 191,930 patients were diagnosed with prostate cancer (PCa), and 33,330 died of that disease in the US. PCa is the second leading cause of cancer-related death in men in the US alone [1] and is increasing in its incidence and mortality in the world. Most cases initially diagnosed are localized to the prostate and found in men between 60 and 70 years old with life expectancy more than 15 years. The improvement of surgical techniques such as laparoscopic surgery and robotic surgery has been proposed. These techniques are expected to improve patients’ quality of life and oncologic and survival outcomes after RP [3]. Identifying patients at increased risk of BCR would allow for tailoring of evidence-based follow-up intensity and could improve counseling and decision-making regarding adjuvant or early salvage therapy [5]
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