Variation in Management of Prostate Specific Antigen Persistence After Radical Prostatectomy: Data From the MUSIC Collaborative

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

NTRODUCTION AND OBJECTIVE: Post-prostatectomy PSA persistence (PP) represents a high-risk cohort whose optimal treatment is unknown and may be distinct from conventional salvage approaches for biochemical recurrence (BCR). Herein, we compare management of patients with PP and BCR and explore variability in treatment patterns within the Michigan Urological Surgery Improvement Collaborative(MUSIC). METHODS: The MUSIC registry was queried for patients who underwent radical prostatectomy (RP) between January 1, 2012 and June 30, 2024 and experienced a post-RP PSA event (PP or BCR). PP was defined as a PSA of >= 0.14 at first post-RP measurement. BCR was defined as a PSA >= 0.2 or PSA >= 0.1 with subsequent treatment after an initially undetectable PSA. Secondary treatment was defined as receipt of radiation or systemic treatment following a PSA event. Time to secondary treatment was compared between PP and BCR via Kaplan-Meier estimates and a log rank test. Multivariable Cox models were fit to evaluate time from PSA event to treatment adjusting for biopsy and, separately, RP pathologic variables. RESULTS: Among 20,829 patients undergoing RP, 1,720(8.3%) had PP and 2,617 (Kaplan-Meier estimated 5-year rate of 24%) had BCR. PSA at treatment was higher among patients with PP (median [IQR] 1.00 [0.40-2.84]) than BCR (0.23 [0.17-0.40]).Treatment occurred within 6 months of PSA event in 72% of PP and61% of BCR (Kaplan-Meier plot in Figure 1). Accounting for demographic, baseline clinical and either biopsy or prostatectomy pathology, BCR (vs. PP) had a significantly lower hazard of secondary treatment (biopsy model: HR 0.84, 95% CI [0.78-0.92],p< 0.001; prostatectomy model: HR 0.90, 95% CI [0.83-0.98],p=0.02). Radiation monotherapy was used in 60% of treated BCR patients, but only 35% of PP. CONCLUSIONS: PP patients are a distinct, extra high-risk cohort with higher PSA at the time of secondary treatment, two-thirds of which is outside the typical salvage window (< =0.5 ng/dL). While PP patients undergo higher rates of secondary treatment overall, further work is needed to elucidate whether they should be treated more aggressively still.

Volume

213

Issue

5S

First Page

e1199

Last Page

e1199

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001110140.31907.5b.25

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