Natural history of an immediately detectable PSA following radical prostatectomy in a contemporary cohort

Background A detectable prostate‐specific antigen (PSA) following radical prostatectomy (RP) is an unfavorable prognostic factor. However, not all men with a detectable PSA experience recurrence. We describe the natural history and outcomes in men with a detectable PSA following RP in a contemporary cohort. Methods A retrospective analysis of men who underwent RP for non‐metastatic prostate cancer at the University of California, San Francisco from 2000 to 2020 was performed. A detectable PSA was defined as PSA ≥ 0.03 ng/ml within 6 months of RP. Cox regression models tested the effect of detectable PSA on the development of metastasis, prostate cancer‐specific mortality, and overall survival. Results We identified 2941 men who had RP with 408 (13.9%) with a detectable PSA within the first 6 months. The median follow‐up was 4.42 years (interquartile range [IQR], 2.58–8.00). In total, 296 (72.5%) men with a detectable PSA had salvage treatment at a median of 6 months (IQR, 4–11). One hundred sixteen of these men had PSA failure after salvage treatment at a median of 2.0 years (IQR, 0.7–3.8). On multivariable Cox regression, the risk of development of metastasis (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.09; p = .01), prostate cancer‐specific mortality (HR, 1.13; 95% CI, 1.05–1.21; p = .0005), and overall mortality (HR, 1.07; 95% CI, 1.03–1.12; p = .002) was associated with PSA velocity after salvage treatment in men with a detectable PSA. Conclusions Men with a detectable PSA after RP may have excellent long‐term outcomes. PSA velocity after salvage treatment may be an important predictor for the development of metastasis, prostate cancer‐specific mortality, and overall mortality.