PROSTATE-SPECIFIC ANTIGEN LEVELS AFTER RADICAL PROSTATECTOMY AND IMMEDIATE ADJUVANT HORMONAL TREATMENT FOR STAGE D1 PROSTATE-CANCER ARE PREDICTIVE OF EARLY DISEASE OUTCOME

Detectable prostate-specific antigen (PSA) levels (greater than or equ al to 0.1 ng/ml) after radical prostatectomy Prostate cancer (RPx) for prostate cancer are consistent with residual disease. Conversely, and rogen deprivation therapy that produces 'negative' PSA values may not reflect actual disease status. One hundred forty-four patients with st age D1 prostate cancer treated with RPx and immediate adjuvant hormona l therapy (IAHT) had preoperative PSA tests and serial PSA evaluation up to 5.5 years postoperatively. Initial postoperative PSA levels (Hyb ritech method), performed a median of 3.7 months postoperatively, were undetectable (<0.1 ng/ml) in 72% of patients, 0.1 ng/ml in 10%, 0.2 n g/ml in 8%, and greater than or equal to 0.3 ng/ml in 10%. Among patie nts whose initial PSA levels were detectable, 84% attained an undetect able level at a median time of 14.4 months postoperatively. The 3-year clinical progression rate after the initial postoperative (3.7 months ) PSA determination was higher (20%) for those patients with a detecta ble PSA level compared with those with an undetectable level (7%; p = 0.09). Mean time to last PSA determination was 2.6 years (range 0.2-5. 2 years). The course of the follow-up PSA values was classified for 12 6 patients as (a) negative (all PSA levels undetectable or decreasing) , (b) solitary spikes (a one-time increase in PSA level), (c) positive (two or more increasing PSA levels), or (d) indeterminate. For the 74 patients (59%) with a negative course, only 1 progressed clinically. Similarly, no clinical progression has been observed in the 21 patient s with solitary spikes, and only one progression has been noted in the 12 patients with an indeterminate course. Nineteen patients had a pos itive PSA course, with 9 (47%) having had clinical progression. Eight of these clinical progressions were preceded by an increasing PSA valu e at a median time of 14 months (range 4-21 months) earlier. We conclu de that PSA values after RPx and IAHT for stage D1 prostate cancer see m useful in that serial increases in PSA are associated with a high ra te of clinical progression and often with significant lead time.