CHICAGO—High confirmatory PSA levels at the time of biochemical recurrence (BCR) of prostate cancer following radical prostatectomy (RP) predicts distant metastasis, investigators concluded in a poster presented at the 2019 American Urological Association annual meeting.
Compared with patients with a confirmatory PSA (cPSA) staying at 0.2 ng/mL (reference group), those with cPSA levels above 0.3 ng/mL had incrementally greater risks of distant metastasis, Yongmei Chen, MD, of the Center for Prostate Disease Research (CPDR), and colleagues reported. Specifically, patients with a cPSA level of 0.31 to 0.40 and 0.41 to 0.91 ng/mL had a significant 97% and 75% increased likelihood of distant metastasis, respectively, in adjusted analyses. The risk was 4-fold higher among those with a cPSA greater than 0.91 ng/mL.
The study included 1823 patients who experienced BCR (defined as a post-RP PSA level of 2 ng/mL or higher confirmed by a successive PSA level of 0.2 ng/mL or higher). In 328 patients, (18%) the cPSA value remained at 0.2 ng/mL. The other patients had a median cPSA of 0.4 ng/mL. Pathologic stage T3 and Gleason sum 4+3 and 8 to 10 were significantly associated with higher cPSA levels. Dr Chen’s team found no significant difference cPSA distribution between white and black men.
The investigators concluded that cPSA can be used in addition to PSA doubling time (PSADT) as an early surrogate of future development of distant metastasis. PSADT is widely accepted as a surrogate for distant metastasis and cancer-specific death, they noted, but PSADT is not always calculable for all patients because it requires multiple PSA measurements following BCR. In addition, PSA levels are affected by receipt of salvage treatment.