Incidence, Variation, and Predictors 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

INTRODUCTION AND OBJECTIVE: Post-prostatectomy PSA persistence (PP) is sub-optimally characterized and likely distinct from typical biochemical recurrence (BCR). Here, we identify incidence, variation, and predictors of PP within the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODS: The MUSIC registry was queried for patients undergoing radical prostatectomy (RP) between January 1, 2012 and June 30, 2024. PP was defined as a PSA of >= 0.14 at first postoperative measurement. BCR was defined as a PSA >= 0.2 or PSA >= 0.1 with subsequent treatment after an initially undetectable PSA. Incidence of these outcomes was calculated at the collaborative level as well as individual practice level as a measure of variation. Clinicopathologic variables and treatment were compared between PP and BCR. Finally, mixed-effects multivariable logistic regression models were used to identify factors associated with post-operative PP. RESULTS: Amongst 20,829 patients, 1,720 (8.3%) had PP and 2,617 (Kaplan-Meier estimated 5-year rate of 24%) had BCR. Significant variation in PP and BCR rates were noted between practices (Figure 1). Table 1 shows higher rates of high-risk features amongst PP compared with BCR. On multivariable regression, African-American race, pre-RP PSA, cT stage, and higher biopsy ISUP grade group (GG), pT stage, RP GG, and positive margins were significantly associated with increased odds of postprostatectomy PP (all p< 0.001 except race, p=0.03). CONCLUSIONS: Nearly one in ten patients have PP following prostatectomy with significant practice-level variation. These patients represent an extremely high-risk population based on associated clinical factors that appears distinct from patients developing delayed BCR. Future work will elucidate whether conventional treatment paradigms appropriately manage the increased risk of this cohort.

Volume

213

Issue

5S

First Page

e789

Last Page

e789

Comments

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

DOI

10.1097/01.JU.0001109988.34650.0d.14

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