Prostate-specific antigen levels after radical prostatectomy and immediate adjuvant hormonal treatment for stage D1 prostate cancer are predictive of early disease outcome.

Abstract

Detectable prostate-specific antigen (PSA) levels (> or = 0.1 ng/ml) after radical prostatectomy (RPx) for prostate cancer are consistent with residual disease. Conversely, androgen deprivation therapy that produces 'negative' PSA values may not reflect actual disease status. One hundred forty-four patients with stage D1 prostate cancer treated with RPx and immediate adjuvant hormonal therapy (IAHT) had preoperative PSA tests and serial PSA evaluation up to 5.5 years postoperatively. Initial postoperative PSA levels (Hybritech method), performed a median of 3.7 months postoperatively, were undetectable (< 0.1 ng/ml) in 72% of patients, 0.1 ng/ml in 10%, 0.2 ng/ml in 8%, and > or = 0.3 ng/ml in 10%. Among patients whose initial PSA levels were detectable, 84% attained an undetectable level at a median time of 14.4 months postoperatively. The 3-year clinical progression rate after the initial postoperative (3.7 months) PSA determination was higher (20%) for those patients with a detectable PSA level compared with those with an undetectable level (7%; p = 0.09). Mean time to last PSA determination was 2.6 years (range 0.2-5.2 years). The course of the follow-up PSA values was classified for 126 patients as (a) negative (all PSA levels undetectable or decreasing), (b) solitary spikes (a one-time increase in PSA level), (c) positive (two or more increasing PSA levels), or (d) indeterminate. For the 74 patients (59%) with a negative course, only 1 progressed clinically. Similarly, no clinical progression has been observed in the 21 patients with solitary spikes, and only one progression has been noted in the 12 patients with an indeterminate course.(ABSTRACT TRUNCATED AT 250 WORDS)