From the Guidelines
Routine PSA monitoring is recommended after prostatectomy for prostate cancer, with checks every 6 to 12 months for the first 5 years, then annually thereafter, as stated in the American Cancer Society prostate cancer survivorship care guidelines 1. This monitoring schedule allows for early detection of cancer recurrence when additional treatments like radiation therapy or hormone therapy might be most effective.
- The PSA should be undetectable (typically <0.1 ng/mL) after complete removal of the prostate.
- Any detectable PSA may indicate recurrent disease, with values of 0.2 ng/mL or higher generally considered biochemical recurrence, as defined by the AUA 1.
- The first PSA check should occur approximately 6-8 weeks after surgery to establish a baseline.
- If PSA begins to rise, more frequent testing may be needed, and imaging studies might be recommended. Key considerations for PSA monitoring after prostatectomy include:
- The risk of biochemical recurrence, which is estimated to occur in approximately 20-40% of men within 10 years after prostatectomy 1.
- The potential benefits of early intervention, including improved treatment outcomes and survival.
- The importance of patient counseling and informed decision-making regarding PSA monitoring and treatment options, as emphasized in the ESMO clinical practice guidelines for prostate cancer 1.
From the Research
Routine PSA Checking after Prostatectomy
- Routine Prostate-Specific Antigen (PSA) checking is recommended after prostatectomy to monitor for residual cancer or recurrence 2, 3, 4, 5, 6.
- A first serum total PSA assay is recommended during the first three months after treatment, and when PSA is detectable, PSA assay should be repeated three months later to confirm this elevation and to estimate the PSA doubling time (PSADT) 2.
- In the absence of residual cancer, PSA becomes undetectable by the first month after total prostatectomy, with a value of less than 0.1 ng/ml (or less than 0.07 ng/ml) for the ultrasensitive assay method and less than 0.2 ng/ml for the other methods 2, 6.
- A consensus has been reached to define recurrence as PSA greater than 0.2 ng/ml confirmed on two successive assays 2, 5.
Definition of PSA Recurrence
- The definition of PSA recurrence dramatically affects the perceived success of therapy, and patients with a postoperative PSA value greater than 0.2 ng/mL are at very high risk of developing an additional rise in PSA 5.
- The use of higher PSA cutpoints to define recurrence resulted in a lower 5-year risk of PSA recurrence, with a 5-year risk of PSA recurrence using a greater than 0.1 ng/mL cutpoint resulting in a 43% risk of recurrence compared with only 23% for a greater than 0.5 ng/mL cutpoint 5.
Early Detection of Residual Cancer
- An ultrasensitive assay for PSA can detect residual cancer after radical prostatectomy much earlier than current immunoassays for PSA, with a median detection time of 202 days and a mean detection time of 310 days earlier than the standard assay 6.
- Early detection of residual cancer may improve long-term survival by allowing for earlier institution of adjuvant therapy 6.