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BJC Open article

British Journal of Cancer (2000) 83, 1432–1436. doi:10.1054/bjoc.2000.1474
Published online 14 November 2000

Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival

A P Doherty1, M Bower2, G L Smith1, R Miano1, E M Mannion3, H Mitchell4 and T J Christmas1

  1. 1Department of Urology, Charing Cross Hospital, Fulham Palace Road, London
  2. 2Department of Medical Oncology, Chelsea and Westminster Hospital, Fulham Road, London
  3. 3Department of Histopathology, Charing Cross Hospital, Fulham Palace Road, London
  4. 4Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London

Received 23 December 1999; Revised 25 July 2000; Accepted 9 August 2000



Radical retropubic prostatectomy is considered by many centres to be the treatment of choice for men aged less than 70 years with localized prostate cancer. A rise in serum prostate-specific antigen after radical prostatectomy occurs in 10–40% of cases. This study evaluates the usefulness of novel ultrasensitive PSA assays in the early detection of biochemical relapse. 200 patients of mean age 61.2 years underwent radical retropubic prostatectomy. Levels ≤ 0.01ng ml–1 were considered undetectable. Mean pre-operative prostate-specific antigen was 13.3ng ml–1. Biochemical relapse was defined as 3 consecutive rises. The 2-year biochemical disease-free survival for the 134 patients with evaluable prostate-specific antigen nadir data was 61.1% (95% CI: 51.6–70.6%). Only 2 patients with an undetectable prostate-specific antigen after radical retropubic prostatectomy biochemically relapsed (3%), compared to 47 relapses out of 61 patients (75%) who did not reach this level. Cox multivariate analysis confirms prostate-specific antigen nadir ≤ 0.01ng ml–1 to be a superb independent variable predicting a favourable biochemical disease-free survival (P < 0.0001). Early diagnosis of biochemical relapse is feasible with sensitive prostate-specific antigen assays. These assays more accurately measure the prostate-specific antigen nadir, which is an excellent predictor of biochemical disease-free survival. Thus, sensitive prostate-specific antigen assays offer accurate prognostic information and expedite decision-making regarding the use of salvage prostate-bed radiotherapy or hormone therapy. © 2000 Cancer Research Campaign


prostate cancer; PSA nadir; radical retropubic prostatectomy



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