BERKELEY, CA (UroToday.com) - Radical prostatectomy (RP) has been able to provide favorable oncological control and prolonged survival for localized prostate cancer (PCa) by reducing the risks of metastasis and local tumor progression. The goal of RP is to completely remove the prostate; however, a proportion of patients inevitably demonstrate adverse pathologic features, representatively, positive surgical margin (PSM). The presence of a PSM is an independent predictor of biochemical recurrence (BCR) and is the most common pattern of disease relapse. However, in everyday clinical practice, we note that not all patients with PSM develop BCR, indicating that residual cancer is not unconditionally destined to recur.
Considerable efforts have been devoted to identifying features that can predict early BCR and clinical progression following RP. However, for an independent subset of patients with PSMs, currently available prediction tools may not reliably predict outcome, and additional predictors are needed to distinguish those who are prone to recurrence and would benefit from adjuvant therapy from those who can be safely observed. We revealed that patients with PSMs following RP who show early decline (< 6 weeks) to undetectable PSA may have a low risk of BCR, comparable to that of patients with negative surgical margins. These observations suggest time to undetectable PSA as a biomarker for disease progression, which may aid in counseling of patients. Yet, large-scale prospective studies and external validations are warranted in order to strengthen our results as supportive data for postoperative PSA follow-up guidelines. The retrospective nature of the study was the main limitation.
Written by:
Kyo Chul Koo and Koon Ho Rha as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea