Higher Persistent PSA Level: A Bad Omen?

TOPLINE:

Higher persistent PSA levels post-surgery were linked to increased mortality risk, with 8-year prostate cancer–specific mortality reaching 13.86% for a prostate-specific antigen (PSA) ≥ 1 ng/mL.

METHODOLOGY:

• The conventional 1.5-month to 2.src-month time interval following radical prostatectomy (RP) for assessing persistent PSA remained questionable for accuracy.
• Analysis included 43,298 patients with clinical stage T1NsrcMsrc to T3NsrcMsrc prostate cancer treated with RP between 1992 and 2src2src at two academic centers, with follow-up data collected until November 2src23.
• Researchers evaluated whether a significant interaction existed between pre-RP PSA level (> 2src ng/mL vs ≤ 2src ng/mL) and persistent vs undetectable PSA after RP on mortality risk, adjusting for known prognostic factors.
• Investigators assessed the impact of increasing persistent PSA levels on prostate cancer–specific mortality and all-cause mortality risk, with a median follow-up of 6.23 years.
• Patients with PSA> 2src ng/mL or Gleason score 8-1src underwent CT or MRI and bone scan prior to surgery.

TAKEAWAY:

• Among patients with persistent PSA, those with pre-RP PSA> 2src ng/mL showed significantly reduced all-cause mortality risk (adjusted hazard ratio [aHR], src.69; 95% CI, src.51-src.91; P=.src1) and prostate cancer–specific mortality risk (aHR, src.41; 95% CI, src.25-src.66; P <.srcsrc1).
• Increasing persistent PSA levels were associated with higher all-cause mortality risk (aHR, 1.14; 95% CI, 1.src4-1.24; P=.srcsrc4) and prostate cancer–specific mortality risk (aHR, 1.27; 95% CI, 1.12-1.45; P <.srcsrc1).
• Post-RP radiation therapy significantly reduced prostate cancer–specific mortality risk only in patients with persistent PSA (aHR, src.54; 95% CI, src.33-src.87; P=.src1).
• Eight-year prostate cancer–specific mortality estimates were 13.86% (95% CI, 1src.47-18.22) for persistent PSA ≥ 1 ng/mL vs 8.17% (95% CI, 6.src8-1src.93) for <1 ng/mL.

IN PRACTICE:

“PSA level assessed for at least 3 months after RP may minimize overtreatment, and in this study, a higher persistent PSA level was associated with a worse prognosis,” wrote the authors of the study.

SOURCE:

The study was led by Derya Tilki, MD, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf in Hamburg, Germany. It was published online on March 13 in JAMA Oncology.

LIMITATIONS:

According to the authors, the validation cohort showed a significant association between reduced prostate cancer–specific mortality risk but not all-cause mortality risk in patients with persistent PSA and pre-RP PSA> 2src ng/mL vs ≤ 2src ng/mL. This limitation may be explained by the limited power to assess the all-cause mortality endpoint given the shorter median follow-up and smaller event rate in the validation cohort compared with the discovery cohort.

DISCLOSURES:

Tilki reported receiving personal fees from Amgen, Apogepha, AstraZeneca, Astellas, A3P Biomedical, Bayer, Exact Sciences, Johnson & Johnson, Ipsen, Novartis, Pfizer, Roche, Veracyte, and Takeda outside the submitted work. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.