Association between PSA values and surveillance quality after prostate cancer surgery

Christina Hunter Chapman^{1

2}, Megan E V Caram^{1

3}, Archana Radhakrishnan⁴, Alexander Tsodikov⁵, Curtiland Deville⁶, Jennifer Burns¹, Alexander Zaslavsky⁷, Michael Chang⁸, John T Leppert⁹, Timothy Hofer^{1

4}, Anne E Sales^{1

10}, Sarah T Hawley^{1

4}, Brent K Hollenbeck⁷, Ted A Skolarus^{1

7}

Affiliations

¹ Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
² Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
³ Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
⁶ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
⁷ Department of Urology, University of Michigan, Ann Arbor, MI, USA.
⁸ Hunter Holmes McGuire Veterans Affairs Healthcare System, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA.
⁹ Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System and the Department of Urology, Stanford University, Stanford, CA, USA.
¹⁰ Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.

PMID: 31691526
PMCID: PMC6912050
DOI: 10.1002/cam4.2663

Association between PSA values and surveillance quality after prostate cancer surgery

Christina Hunter Chapman et al. Cancer Med. 2019 Dec.

. 2019 Dec;8(18):7903-7912.

doi: 10.1002/cam4.2663. Epub 2019 Nov 5.

Authors

Affiliations

¹ Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
² Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
³ Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
⁶ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
⁷ Department of Urology, University of Michigan, Ann Arbor, MI, USA.
⁸ Hunter Holmes McGuire Veterans Affairs Healthcare System, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA.
⁹ Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System and the Department of Urology, Stanford University, Stanford, CA, USA.
¹⁰ Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.

PMID: 31691526
PMCID: PMC6912050
DOI: 10.1002/cam4.2663

Abstract

Background: Although prostate-specific antigen (PSA) testing is used for prostate cancer detection and posttreatment surveillance, thresholds in these settings differ. The screening cutoff of 4.0 ng/mL may be inappropriately used during postsurgery surveillance, where 0.2 ng/mL is typically used, creating missed opportunities for effective salvage radiation treatment. We performed a study to determine whether guideline concordance with annual postoperative PSA surveillance increases when PSA values exceed 4 ng/mL, which represents a screening threshold that is not relevant after surgery.

Methods: We used US Veterans Health Administration data to perform a retrospective longitudinal cohort study of men diagnosed with nonmetastatic prostate cancer from 2005 to 2008 who underwent radical prostatectomy. We used logistic regression to examine the association between postoperative PSA levels and receipt of an annual PSA test.

Results: Among 10 400 men and 38 901 person-years of follow-up, annual guideline concordance decreased from 95% in year 1 to 79% in year 7. After adjustment, guideline concordance was lower for the youngest and oldest men, Black, and unmarried men. Guideline concordance significantly increased as PSA exceeded 4 ng/mL (adjusted odds ratio 2.20 PSA > 4-6 ng/mL vs PSA > 1-4 ng/mL, 95% confidence interval 1.20-4.03; P = .01).

Conclusions: Guideline concordance with prostate cancer surveillance increased when PSA values exceeded 4 ng/mL, suggesting a screening threshold not relevant after prostate cancer surgery, where 0.2 ng/mL is considered treatment failure, is impacting cancer surveillance quality. Clarification of PSA thresholds for early detection vs cancer surveillance, as well as emphasizing adherence for younger and Black men, appears warranted.

Keywords: mass screening; prostate-specific antigen; prostatectomy; prostatic neoplasms; survivorship.

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Conflict of interest statement

None declared.

Figures

**Figure 1**
Annual guideline concordance for prostate‐specific antigen (PSA) surveillance among 10 400 patients after radical prostatectomy in a national delivery system according to race and ethnicity

**Figure 2**
Guideline concordance by prior year prostate‐specific antigen (PSA) values. Model‐predicted annual PSA guideline concordance by prior year PSA value among 10 400 patients surviving at least 2 years without receipt of salvage therapy. *denotes statistically significant guideline concordance compared to PSA > 1 and ≤4 (P < .05)

**Figure 3**
Model‐predicted annual prostate‐specific antigen (PSA) guideline concordance after radical prostatectomy by age

See this image and copyright information in PMC

References

1. Uchio EM, Aslan M, Wells CK, Calderone J, Concato J. Impact of biochemical recurrence in prostate cancer among US veterans. Arch Intern Med. 2010;170(15):1390‐1395. - PubMed
1. Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long‐term biochemical disease‐free and cancer‐specific survival following anatomic radical retropubic prostatectomy. The 15‐year Johns Hopkins experience. Urol Clin North Am. 2001;28(3):555‐565. - PubMed
1. Carrie C, Hasbini A, de Laroche G, et al. Salvage radiotherapy with or without short‐term hormone therapy for rising prostate‐specific antigen concentration after radical prostatectomy (GETUG‐AFU 16): a randomised, multicentre, open‐label phase 3 trial. Lancet Oncol. 2016;17(6):747‐756. - PubMed
1. Shipley WU, Seiferheld W, Lukka HR, et al. Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med. 2017;376(5):417‐428. - PMC - PubMed
1. Tendulkar RD, Agrawal S, Gao T, et al. Contemporary update of a multi‐institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J Clin Oncol. 2016;34:3648‐3654. - PubMed

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Association between PSA values and surveillance quality after prostate cancer surgery

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Association between PSA values and surveillance quality after prostate cancer surgery

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