Large Study Rules PSA Test Unnecessary >10 Years after Radical Prostatectomy

Orlando, FL—Most cases of prostate cancer biochemical recurrence after radical prostatectomy occurs within 10 years of surgery, and men who progress after that period are less likely to develop metastasis or die from prostate cancer, according to results of a large study conducted by a team of experts at Johns Hopkins Medical School. The team concluded that clinicians could counsel patients about risks but stop prostate-specific antigen (PSA) testing 10 years postoperative. Stacy Loeb, MD, chief urology resident at Johns Hopkins, reported on their findings at the 2011 Genitourinary Cancers Symposium.

“It’s reasonable to stop PSA testing 10 years after the radical prostatectomy,” Dr Loeb said, adding that this is the first large study with long-term follow-up to evaluate the need for PSA, which can provoke great anxiety. “There are financial burdens and psychological complications of” repeating the test.

Large Study, Clear Results
Dr Loeb and colleagues studied 10,609 men with clinically localized prostate cancer who underwent radical prostatectomy at Johns Hopkins between 1978 and 2009, did not receive hormonal therapy before surgery, and had accessible data about follow-up care. At some point, 1648 men (15.5%) developed biochemical recurrence.

“The vast majority [of recurrences] occurred within the first 5 years, and then it dramatically dropped off,” Dr Loeb pointed out. “Only 6.4% of the recurrences were after 10 years. There were very few of them.”

Supporting the team’s conclusion that PSA was not necessary after 10 years were their data showing that:

• Men with early recurrences were more likely to develop metastasis than men with late recurrences
• Men who progressed early on were more likely to die from prostate cancer than other men
• Among the men with a Gleason score of 6 with late recurrence, no one subsequently died.

“Late recurrences are of a more indolent fashion, most likely related to the tumor biology,” Dr Loeb emphasized. “It is so slow for the recurrence. It takes a long time to develop into a clinical event.”

Dr Loeb said she hoped other prostate cancer experts with long-term data will analyze those cases and help to develop a guideline for PSA testing, indicating that it is safe to stop PSA screening if the cancer is undetectable after 10 years.

“We’re also interested in looking to see if we can space it [the testing] out more, perhaps every 2 or 5 years, which would decrease cost and anxiety,” Dr Loeb said.