Optimal prostate-specific antigen thresholds for early salvage therapy after robotic-assisted radical prostatectomy.

Authors

Jong Hoon Lee, Chung Un Lee, Wan Song, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon

Published in

Urologic oncology. Volume 44. Issue 9. Pages 522-527.

Abstract

Biochemical recurrence (BCR) after radical prostatectomy is defined as prostate-specific antigen (PSA) >0.2 ng/ml with a subsequent increase. However, early salvage therapy at lower PSA levels may improve outcomes. We aimed to evaluate optimal PSA thresholds for predicting BCR after robotic-assisted radical prostatectomy.
We retrospectively analyzed 595 patients who underwent robotic-assisted radical prostatectomy by a single surgeon between 2015 and 2019, excluding those with positive lymph nodes. PSA persistence was defined based on the first postoperative PSA measurement at 1 month. BCR was defined as PSA >0.2 ng/ml with a subsequent increase. Patients were stratified into 3 groups: PSA ≥0.03, ≥0.05, and ≥0.1 ng/ml, with a subsequent increase. Kaplan-Meier analysis was used to assess BCR-free survival, with subgroup analysis stratified by the Cancer of the Prostate Risk Assessment-Surgical classification.
Median follow-up was 4.8 (interquartile range [IQR] 4.2-5.7) years. PSA ≥0.03, ≥0.05, and ≥0.1 ng/ml exhibited a 5-year BCR-free survival of 63.8%, 34.8%, and 0.0%, respectively, and a median time (IQR) of 0.3 (0.2-0.7), 0.8 (0.3-1.7), and 1.6 (0.7-2.8) years. The median time to recurrence was not reached in the PSA ≥0.03 ng/ml group, whereas it was 1.9 (IQR 1.6-2.3) and 0.7 (IQR 0.5-0.8) years for those with PSA ≥0.05 and ≥0.1 ng/ml, respectively. High-risk patients with PSA ≥0.03 ng/ml had significantly shorter survival than did others (median 1.1 years; 5-year rate 17.3%). Notably, the generalizability of these results is limited by the study's retrospective nature.
BCR occurred in approximately 1 year in patients with PSA ≥0.1 ng/ml and high-risk patients with PSA ≥0.03 ng/ml. Our findings demonstrate that a lower PSA threshold of 0.03 ng/ml effectively sub-stratifies patients at risk for early recurrence. Therefore, early salvage therapy should be considered at lower PSA levels than the conventional definition, particularly for high-risk patients.

PMID:
42618170
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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