EVALUATION OF SERUM PROSTATE-SPECIFIC ANTIGEN VELOCITY AFTER RADICAL PROSTATECTOMY TO DISTINGUISH LOCAL RECURRENCE FROM DISTANT METASTASES

Objective. Serum prostate-specific antigen (PSA) values are most usefu l for prediction of disease recurrence after surgery. It is unknown wh ether a detectable PSA level after surgery indicates a local recurrenc e potentially benefiting from pelvic irradiation or distant metastases requiring hormonal treatment. Methods. We analyzed postoperative rate of change of serum PSA levels as a predictor of local versus distant disease recurrence after radical prostatectomy. Between 1982 and 1991, 1,058 men underwent radical prostatectomy for localized prostate canc er and follow-up consisted of determining serum PSA levels and digital rectal examinations. Clinical follow-up of 542 men for four or more y ears and 78 men for eight or more years yielded ten-year actuarial dis ease recurrence rates of 4 percent for local recurrence, 8 percent for distant metastases, and 23 percent for an isolated elevation of serum PSA level only. Fifty-one patients with isolated elevations of PSA le vels only were followed expectantly until they were diagnosed with eit her local or distant metastases. Results. A linear mixed effects regre ssion analysis was used to model these data. Using these models, the t ime to a serum PSA level of 0.5 ng/mL, the PSA level one year followin g surgery, pathologic stage, Gleason sum, and the rate of change of PS A (PSA velocity [PSAV]) were tested as predictors of local versus dist ant metastases. A combination of PSAV, pathologic stage, and Gleason g rade best distinguished local from distant metastases. Conclusions. Th ese data suggest that PSAV in men with an isolated elevation of PSA le vels following radical prostatectomy might aid in clinical decision ma king.