There are multiple definitions of biochemical recurrence for prostate cancer treatment post surgery. This causes confusion both within the patient community and the medical community. It would be very helpful if we could standardize a simple measure, PSA as the biomarker for a biochemical recurrence. Standardization post surgery would give us a better way to decide at what point additional treatment would most benefit a man with recurrent prostate cancer.
To accomplish this goal researchers reviewed the long-term prostatectomy outcomes to assess the most appropriate prostate specific antigen cut point that predicts future disease progression.
The study was large, including 13,512 men with cT1-2N0M0 prostate cancer who underwent radical prostatectomy between 1987 and 2010. They evaluated single prostate specific antigen cut points of 0.2, 0.3, 0.4 and 0.5 ng/ml or greater.
At a median postoperative follow up of 9.1 years a detectable prostate specific antigen developed in 5,041 men and systemic progression developed in 512. After reaching the prostate specific antigen cut point of 0.2, 0.3 and 0.4 ng/ml, the percentage of men experiencing a continued prostate specific antigen increase over 5 years was 61%, 67% and 74%, respectively, plateauing at 0.4 ng/ml. They found that the strongest association between biochemical recurrence and systemic progression occurred using a single prostate specific antigen cut point of 0.4 ng/ml or greater.
The researchers concluded that a prostate specific antigen (PSA) cut point of 0.4 ng/ml or greater reflects the threshold at which a prostate specific antigen increase becomes durable and shows the strongest correlation with subsequent systemic progression. Consideration should be given to using a prostate specific antigen of 0.4 ng/ml or greater as the standard biochemical recurrence definition after radical prostatectomy.