The Relationship of the Intensity of Posttreatment Prostate-Specific Antigen Surveillance and Prostate Cancer Outcomes: Results From a Population-Based Cohort

Abstract Objective To determine whether higher intensity of prostate-specific antigen (PSA) surveillance was associated with earlier detection of biochemical recurrence (BCR) or survival. Patients and Methods We identified a population-based cohort of 832 men diagnosed with nonmetastatic prostate ca...

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Published in:Mayo Clinic proceedings 2012-06, Vol.87 (6), p.540-547
Main Authors: Nabhan, Mohammed, MD, Kim, Simon P., MD, MPH, Shah, Nilay D., PhD, Bagniewski, Stephanie M., BS, Shi, Qian, PhD, Karnes, R. Jeffrey, MD, Weight, Christopher J., MD, Davis, Brian J., MD, PhD, Kohli, Manish, MD, Tilburt, Jon C., MD
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Brachytherapy
Combined Modality Therapy
General aspects
Gynecology. Andrology. Obstetrics
Humans
Immune system
Internal Medicine
Male
Male genital diseases
Medical sciences
Middle Aged
Multivariate Analysis
Nephrology. Urinary tract diseases
Original
Patient outcomes
Population Surveillance
Prostate cancer
Prostate-Specific Antigen - blood
Prostatectomy
Prostatic Neoplasms - blood
Prostatic Neoplasms - pathology
Prostatic Neoplasms - radiotherapy
Prostatic Neoplasms - surgery
Testing
Treatment Outcome
Tumors
Tumors of the urinary system
Urinary tract. Prostate gland
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Summary:Abstract Objective To determine whether higher intensity of prostate-specific antigen (PSA) surveillance was associated with earlier detection of biochemical recurrence (BCR) or survival. Patients and Methods We identified a population-based cohort of 832 men diagnosed with nonmetastatic prostate cancer between January 1, 1995, and July 31, 2006. These men were treated with radical prostatectomy (RP), brachytherapy or external beam radiation therapy (RT), or primary androgen deprivation therapy or chose watchful waiting. To test the associations of intensity in PSA surveillance with study outcomes, we used a 2-year landmark analysis to assess whether the number of PSA tests during the first 2 years after treatment was associated with earlier detection of BCR, prostate cancer–related mortality, and all-cause mortality. We used landmark analysis to assess the association of PSA intensity, adjusting for clinicopathologic covariate, with outcome. Results Median follow-up time for the entire cohort was 6.7 years. Higher Gleason score was the only clinicopathologic variable associated with higher PSA frequency in multivariable analysis for both the RP and RT groups ( P value of .001 and .05, respectively). After adjustment for other covariates, the frequency of PSA tests during the first 2 years after RP did not increase the ability to detect BCR (hazard ratio, 1.00; 95% confidence interval, 0.84-1.19) or all-cause mortality (hazard ratio, 0.95; 95% confidence interval, 0.70-1.30) in the landmark analysis. Conclusion Higher intensity of PSA surveillance during the 2 years after RP or RT did not improve earlier detection of BCR or survival. Evidence-based guidelines for PSA surveillance after primary treatment are needed.
ISSN:0025-6196
1942-5546
DOI:10.1016/j.mayocp.2012.01.017