Veerman Hans, van der Graaf Sophia H, Meijer Dennie, Hagens Marinus J, Tillier Corinne N, van Leeuwen Pim J, van der Poel Henk G, Vis André N
Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands.
Department of Urology, Amsterdam University Medical Centers, 1066 CX Amsterdam, The Netherlands.
Biomedicines. 2023 Feb 28;11(3):727. doi: 10.3390/biomedicines11030727.
The currently advised follow-up scheme of PSA testing after robot-assisted radical prostatectomy (RARP) is strict and might pose a burden to our healthcare system. We aimed to optimize the 1-year follow-up scheme for patients who undergo RARP.
All patients with histologically-proven prostate cancer (PCa) who underwent RARP between 2018 and August 2022 in the Prostate Cancer Network in the Netherlands were retrospectively evaluated. We excluded patients who underwent salvage RARP and patients who had <1 year of PSA follow-up. Postoperative PSA values were collected. Biochemical persistence (BCP) was defined as PSA level >0.10 ng/mL at 0-4 months after RARP, whereas biochemical recurrence (BCR) was defined as PSA level >0.2 ng/mL at any time point after RARP. We aimed to identify a group of patients who had a very low risk of BCR at different time points after surgery.
Of all 1155 patients, BCP was observed in 151 (13%), of whom 79 (6.8%) had PSA ≥ 0.2 ng/mL. BCR further developed in 51 (4.7%) and 37 (3.4%) patients at 5-8 and 9-12 months after RARP, respectively. In 12 patients, BCR was found at 5-8 months after RARP in the absence of BCP. These patients represented 1.2% (12/1004) of the entire group. In other words, 98.8% (992/1004) of patients who had an unmeasurable PSA level at 0-4 months after RARP also had an unmeasurable PSA level 5-8 months after surgery. Limitations are the retrospective design and incomplete follow-up.
Patients with an unmeasurable PSA level at 3-4 months after RARP may not need to be retested until 12 months of follow-up, as almost 100% of patients will not have the biochemically recurrent disease at 5-8 months of follow-up. This will reduce PSA testing substantially at the cost of hardly any missed patients with recurrent disease.
目前建议的机器人辅助根治性前列腺切除术（RARP）后前列腺特异性抗原（PSA）检测随访方案较为严格，可能给我们的医疗系统带来负担。我们旨在优化接受RARP患者的1年随访方案。
对2018年至2022年8月期间在荷兰前列腺癌网络中接受RARP且组织学证实为前列腺癌（PCa）的所有患者进行回顾性评估。我们排除了接受挽救性RARP的患者以及PSA随访时间不足1年的患者。收集术后PSA值。生化持续性（BCP）定义为RARP后0至4个月时PSA水平>0.10 ng/mL，而生化复发（BCR）定义为RARP后任何时间点PSA水平>0.2 ng/mL。我们旨在确定一组在术后不同时间点BCR风险极低的患者。
在所有1155例患者中，151例（13%）观察到BCP，其中79例（6.8%）PSA≥0.2 ng/mL。分别在RARP后5至8个月和9至12个月，另有51例（4.7%）和37例（3.4%）患者发生BCR。在12例患者中，RARP后5至8个月时在无BCP的情况下发现BCR。这些患者占整个队列的1.2%（12/1004）。换句话说，RARP后0至4个月时PSA水平不可测的患者中，98.8%（992/1004）在术后5至8个月时PSA水平也不可测。局限性在于回顾性设计和随访不完全。
RARP后3至4个月时PSA水平不可测的患者，可能无需在随访12个月前再次检测，因为几乎100%的患者在随访5至8个月时不会出现生化复发疾病。这将大幅减少PSA检测，而几乎不会遗漏复发疾病患者。
