{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:57:01Z","timestamp":1792684621876,"version":"4.5.0"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec id=\"ab-coi250003-4\"><jats:title>Importance<\/jats:title><jats:p>Whether the conventional 1.5-month to 2.0-month time interval following radical prostatectomy (RP) for prostate cancer (PC) is sufficient to accurately document a persistent prostate-specific antigen (PSA) remains unanswered.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250003-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the time necessary to accurately document a persistent PSA level after RP.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250003-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study evaluated whether a significant interaction existed between (1) a pre-RP PSA level greater than 20 ng\/mL vs 20 ng\/mL or less and (2) persistent PSA vs undetectable PSA after RP on PC-specific mortality (PCSM) risk and all-cause mortality (ACM) risk, adjusting for known PC prognostic factors, age at RP, year of RP, and the time-dependent use of post-RP radiation therapy (RT) and androgen deprivation therapy (ADT). Whether an increasing persistent PSA level was associated with a worse prognosis was also investigated. Patients with T1N0M0 to T3N0M0 PC treated with RP between 1992 and 2020 at 2 academic centers were included. Follow-up data were collected until November 2023. Data were analyzed from July 2024 to January 2025.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250003-7\"><jats:title>Exposure<\/jats:title><jats:p>RP.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250003-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Adjusted hazard ratio (aHR) of ACM and PCSM risk.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250003-9\"><jats:title>Results<\/jats:title><jats:p>Of 30\u202f461 patients included in the discovery cohort, the median (IQR) age was 64 (59-68) years; of 12\u202f837 patients included in the validation cohort, the median (IQR) age was 59 (54-64) years. Compared with patients with undetectable PSA, among patients with persistent PSA, a pre-RP PSA level greater than 20 ng\/mL vs 20 ng\/mL or less was significantly associated with reduced ACM risk (aHR, 0.69; 95% CI, 0.51-0.91; <jats:italic>P<\/jats:italic>\u2009=\u2009.01; <jats:italic>P<\/jats:italic> for interaction\u2009&amp;amp;lt;\u2009.001) and PCSM risk (aHR, 0.41; 95% CI, 0.25-0.66; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001; <jats:italic>P<\/jats:italic> for interaction\u2009=\u2009.02). This result remained after adjustment for prostate volume and was confirmed in the validation cohort for PCSM risk and may represent a higher proportion of patients with a pre-RP PSA greater than 20 ng\/mL vs 20 ng\/mL or less who could have reached an undetectable PSA level if additional time for PSA assessment occurred before initiating post-RP therapy for presumed persistent PSA. Notably, there was more frequent and a shorter median time to post-RP RT plus ADT or ADT use in patients with a pre-RP PSA greater than 20 ng\/mL (244 of 446 [54.7%] at a median [IQR] of 2.68 [1.51-4.40] months) vs 20 ng\/mL or less (338 of 972 [34.8%] at a median [IQR] of 3.30 [2.00-5.39] months). These treatment times were shorter than the times to an undetectable PSA in observed patients (median [IQR] of 2.96 [1.84-3.29] months vs 3.37 [2.35-4.09] months, respectively). Increasing persistent PSA level was associated with an increased ACM risk (aHR, 1.14; 95% CI, 1.04-1.24; <jats:italic>P<\/jats:italic>\u2009=\u2009.004) and PCSM risk (aHR, 1.27; 95% CI, 1.12-1.45; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250003-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>PSA level assessed for at least 3 months after RP may minimize overtreatment, and in this study, a higher persistent PSA level was associated with a worse prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.0110","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T15:03:42Z","timestamp":1741878222000},"page":"502","source":"Crossref","is-referenced-by-count":13,"title":["Persistent Prostate-Specific Antigen Following Radical Prostatectomy for Prostate Cancer and Mortality Risk"],"prefix":"10.1001","volume":"11","author":[{"given":"Derya","family":"Tilki","sequence":"first","affiliation":[{"name":"Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany"},{"name":"Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany"},{"name":"Department of Urology, Koc University Hospital, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Connecticut, Storrs"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Statistics, University of Rhode Island, Kingston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartwig","family":"Huland","sequence":"additional","affiliation":[{"name":"Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Graefen","sequence":"additional","affiliation":[{"name":"Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce J.","family":"Trock","sequence":"additional","affiliation":[{"name":"Department of Urology, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misop","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Urology, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony V.","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Brigham and Women\u2019s Hospital and Dana 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after radical prostatectomy (RP): long-term outcomes in the RADICALS-RT trial (NCT00541047).","volume":"35","author":"Parker","year":"2024","journal-title":"Ann Oncol"},{"issue":"20","key":"coi250003r17","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.1200\/JCO.20.03714","article-title":"Adjuvant versus early salvage radiation therapy for men at high risk for recurrence following radical prostatectomy for prostate cancer and the risk of death.","volume":"39","author":"Tilki","year":"2021","journal-title":"J Clin Oncol"},{"issue":"20","key":"coi250003r18","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1200\/JCO.21.02800","article-title":"Adjuvant versus early salvage radiation therapy after radical prostatectomy for pN1 prostate cancer and the risk of death.","volume":"40","author":"Tilki","year":"2022","journal-title":"J Clin 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