External validation of the "optimal PSA follow-up schedule after radical prostatectomy” in a new cohort

Yanai, Yoshinori; Matsumoto, Kazuhiro; Kosaka, Takeo; Takeda, Toshikazu; Tanaka, Nobuyuki; Morita, Shinya; Mizuno, Ryuichi; Shinojima, Toshiaki; Asanuma, Hiroshi; Oya, Mototsugu

doi:10.1007/s10147-020-01676-z

Cited by 6 publications

(12 citation statements)

References 10 publications

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“…Patients with pN1-or pT3b-status were excluded in the study of Swanson et al Other studies showed that patients with pN1 or pT3b had an even higher risk of CSM and should definitely be monitored [17]. Matsumoto et al analyzed the optimal follow-up scheme in patients after RARP based on the PSA-doubling time with the aim to find every single BCR before it exceeds 0.4 ng/mL [18,19]. Their optimal schedule was, for the most part in line with the EAU guidelines, every 3 months for the first year, every 4 months the second year and semiannually thereafter [3].…”

Section: Discussionmentioning

confidence: 99%

Identifying Patients in Whom the Follow-up Scheme after Robot-assisted Radical Prostatectomy Could be Optimized in the First Year after Surgery: Reducing Healthcare Burden

Veerman¹,

Graaf²,

Meijer³

et al. 2023

Preprint

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Background: The currently advised follow-up scheme of PSA-testing after robot-assisted radical prostatectomy (RARP) is strict and might pose a burden to our healthcare system. We aimed to optimize the 1-year follow-up scheme for patients who undergo RARP. Methods: All patients with histologically-proven prostate cancer (PCa) who underwent RARP between 2018 and August 2022 in the Prostate Cancer Network the Netherlands were retrospectively evaluated. We excluded patients who underwent salvage RARP and patients who had &lt;1 year of PSA follow-up. Postoperative PSA-values were collected. Biochemical persistence (BCP) was defined as PSA-level &gt;0.10 ng/mL at 0-4 months after RARP, whereas biochemical recurrence (BCR) was defined as PSA-level &gt;0.2 ng/mL at any time point after RARP. We aimed to identify a group of patients who had a very low risk of BCR at different time-points after surgery. Results: Of all 1155 patients, BCP was observed in 151 (13%), of whom 79 (6.8%) had PSA ≥0.2 ng/mL. BCR further developed in 51 (4.7%), and 37 (3.4%) patients at 5-8 and 9-12 months after RARP, respectively. In 12 patients, BCR was found at 5-8 months after RARP in absence of BCP. These patients represented 1.2% (12/1004) of the entire group. In other words, 98.8% (992/1004) of patients who had an unmeasurable PSA-level at 0-4 months after RARP also had unmeasurable PSA-level 5-8 months after surgery. Limitations are the retrospective design and incomplete follow-up. Conclusions: Patients with an unmeasurable PSA-level at 3-4 months after RARP may not need to be retested until 12 months of follow-up as almost 100% of patients will not have biochemically recurrent disease at 5-8 months of follow-up. This will reduce PSA-testing substantially at the costs of hardly any missed patients with recurrent disease.

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Section: Discussionmentioning

confidence: 99%

Identifying Patients in Whom the Follow-up Scheme after Robot-assisted Radical Prostatectomy Could be Optimized in the First Year after Surgery: Reducing Healthcare Burden

Veerman¹,

Graaf²,

Meijer³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Patients with pN1- or pT3b-status were excluded in the study of Swanson et al Other studies showed that patients with pN1 or pT3b had an even higher risk of CSM and should definitely be monitored [ 17 ]. Matsumoto et al analyzed the optimal follow-up scheme in patients after RARP based on the PSA-doubling time with the aim to find every single BCR before it exceeds 0.4 ng/mL [ 18 , 19 ]. Their optimal schedule was, for the most part, in line with the EAU guidelines, every 3 months for the first year, every 4 months for the second year, and semiannually thereafter [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Identifying Patients in Whom the Follow-Up Scheme after Robot-Assisted Radical Prostatectomy Could Be Optimized in the First Year after Surgery: Reducing Healthcare Burden

et al. 2023

View full text Add to dashboard Cite

Background: The currently advised follow-up scheme of PSA testing after robot-assisted radical prostatectomy (RARP) is strict and might pose a burden to our healthcare system. We aimed to optimize the 1-year follow-up scheme for patients who undergo RARP. Methods: All patients with histologically-proven prostate cancer (PCa) who underwent RARP between 2018 and August 2022 in the Prostate Cancer Network in the Netherlands were retrospectively evaluated. We excluded patients who underwent salvage RARP and patients who had <1 year of PSA follow-up. Postoperative PSA values were collected. Biochemical persistence (BCP) was defined as PSA level >0.10 ng/mL at 0–4 months after RARP, whereas biochemical recurrence (BCR) was defined as PSA level >0.2 ng/mL at any time point after RARP. We aimed to identify a group of patients who had a very low risk of BCR at different time points after surgery. Results: Of all 1155 patients, BCP was observed in 151 (13%), of whom 79 (6.8%) had PSA ≥ 0.2 ng/mL. BCR further developed in 51 (4.7%) and 37 (3.4%) patients at 5–8 and 9–12 months after RARP, respectively. In 12 patients, BCR was found at 5–8 months after RARP in the absence of BCP. These patients represented 1.2% (12/1004) of the entire group. In other words, 98.8% (992/1004) of patients who had an unmeasurable PSA level at 0–4 months after RARP also had an unmeasurable PSA level 5–8 months after surgery. Limitations are the retrospective design and incomplete follow-up. Conclusions: Patients with an unmeasurable PSA level at 3–4 months after RARP may not need to be retested until 12 months of follow-up, as almost 100% of patients will not have the biochemically recurrent disease at 5–8 months of follow-up. This will reduce PSA testing substantially at the cost of hardly any missed patients with recurrent disease.

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“…We considered the ideal PSA range for the detection of BCR to be 0.2-0.4 ng/ mL, at which we can start salvage treatment before the PSA level exceeds 0.5 ng/mL [4]. In our previous studies [8][9][10], we calculated the PSA-DT in patients who underwent RP between 1995 and 2017 and experienced BCR. The majority of the cohort did not undergo NHT.…”

Section: Discussionmentioning

confidence: 99%

“…Patients should be followed up closely during the early phase after RP when aggressive disease recurrence can develop. The risk of rapid BCR gradually decreases over time and the follow-up frequency can be reduced in the late phase [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Negative impact of neoadjuvant hormonal therapy on detecting biochemical recurrence after radical prostatectomy

et al. 2021

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Background Routine use of neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP) is not recommended, but it is sometimes performed to reduce the prostate size and tumor volume or to prevent tumor progression during the wait times for surgery in clinical practice. On the other hand, the impact of NHT on the pattern of biochemical recurrence (BCR) is unknown. Methods We retrospectively examined 1749 consecutive patients who underwent RP between 1996 and 2017. Among the patients who met the inclusion criteria, BCR developed in 240 of non-NHT patients and in 120 of NHT patients during the mean follow-up period of 6.9 years. We examined the impact of NHT on the PSA-doubling time (DT) following BCR at different times after RP. Results The median PSA-DTs in non-NHT patients who experienced BCR in the first year after surgery, between 1 and 2 years, between 2 and 3 years, between

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External validation of the "optimal PSA follow-up schedule after radical prostatectomy” in a new cohort

Cited by 6 publications

References 10 publications

Identifying Patients in Whom the Follow-up Scheme after Robot-assisted Radical Prostatectomy Could be Optimized in the First Year after Surgery: Reducing Healthcare Burden

Identifying Patients in Whom the Follow-up Scheme after Robot-assisted Radical Prostatectomy Could be Optimized in the First Year after Surgery: Reducing Healthcare Burden

Identifying Patients in Whom the Follow-Up Scheme after Robot-Assisted Radical Prostatectomy Could Be Optimized in the First Year after Surgery: Reducing Healthcare Burden

Negative impact of neoadjuvant hormonal therapy on detecting biochemical recurrence after radical prostatectomy

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