Predictors of Follow-Up Visits Post Radical Prostatectomy

Long-term follow-up care among prostate cancer patients is important as biochemical recurrence can occur many years after diagnosis, with 20%–30% of men experiencing biochemical recurrence within 10 years of treatment. This study examined predictors of follow-up care among 1,158 radical prostatectomy patients, treated at the Washington University in St. Louis, within 6 months, 1 year, and 2 years post surgery. Predictors examined included age at surgery, race (Black vs. White), rural/urban status, education, marital status, and prostate cancer aggressiveness. Multivariable logistic regression was used to assess the association between the predictors and follow-up visits with a urologist in 6 months, the 1st year, and the 2nd year post surgery. In a secondary analysis, any follow-up visit with a prostate-specific antigen (PSA) test was included, regardless of provider type. Men that were Black ( 6 months OR: 0.60; 95% CI [0.36, 0.99], 1 year OR: 0.34; 95% CI [0.20, 0.59], 2 year OR: 0.41; 95% CI [0.25, 0.68]), resided in a rural residence ( 1 year OR: 0.61; 95% CI [0.44, 0.85], 2 year OR: 0.41; 95% CI [0.25, 0.68]), or were unmarried ( 2 year OR: 0.69; 95% CI [0.49, 0.97]) had a reduced odds of follow-up visits with a urologist. In models where any follow-up visit with a PSA test was examined, race remained a significant predictor of follow-up. The results indicate that Black men, men residing in a rural residence, and unmarried men may not receive adequate long-term follow-up care following radical prostatectomy. These men represent a high-risk group that could benefit from increased support post treatment.

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Inductive androgen deprivation and radical prostatectomy in T4 prostate cancer: Consecutive assessment of perioperative outcomes and long-term follow up

European Urology Supplements ◽

10.1016/s1569-9056(19)30217-9 ◽

2019 ◽

Vol 18 (1) ◽

pp. e299-e300

Author(s):

M. Saar ◽

C. Niklas ◽

T. Hajili ◽

C-H. Ohlmann ◽

J. Linxweiler ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Androgen Deprivation ◽

Perioperative Outcomes ◽

Long Term Follow Up

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Natural history of an immediately detectable PSA following radical prostatectomy: A description of a contemporary cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.356 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 356-356

Author(s):

Peter Eoin Lonergan ◽

Samuel L. Washington ◽

Janet E. Cowan ◽

Hao Nguyen ◽

Matthew R. Cooperberg ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Natural History ◽

Locally Advanced ◽

Specific Antigen ◽

Salvage Treatment ◽

Post Surgery ◽

History Of

356 Background: Radical prostatectomy (RP) can provide good long-term oncological outcomes in patients with localized and locally advanced prostate cancer (PCa). After RP, prostate specific antigen (PSA) represents the corner stone for follow-up of patients. A persistently detectable PSA immediately following RP is an unfavourable prognostic factor. We described the natural history of the management and outcomes in men with a detectable PSA in an academic cohort. Methods: A retrospective review of prospectively collected clinical and pathologic data from consecutive patients who underwent RP for non-metastatic PCa between 2000 and 2018 was performed. A detectable PSA was defined as PSA ≥ 0.05 ng/ml between 2-6 months post-surgery. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml after 6 months post-surgery or any salvage treatment for a rising PSA. Second recurrence was defined as additional treatment after post-RP salvage treatment. Outcomes were defined as time to other cause mortality (OCM) or prostate cancer specific mortality (PCSM). Results: We identified 499 men with a detectable PSA within 6 months following RP. Median PSA at diagnosis was 7.95 ng/ml (IQR 5.57-12.97). Median CAPRA-S score was 5 (IQR 2-7). Median follow-up was 41 months (IQR 20-77). 296 (59%) underwent salvage treatment for a rising PSA at a median of 5 months. 33 (23%) of these men required further treatment (10 for bone metastases) at a median of 7 months. 203 (41%) of men with an immediately detectable PSA did not undergo any further treatment after RP. Treatment-free survival after post-RP salvage (31 on ADT and 2 underwent salvage RT) in men with a detectable vs undetectable PSA was 86% vs 92% at 1 year, 78% vs 89% at 3 years, 72% vs 86% at 5 years and 70% vs 76% at 10 years (Log-rank p =0.02). Prostate cancer specific survival in men with a detectable vs undetectable PSA was 100% vs 100% at 1 year, 99% vs 100% at 3 years, 96% vs 100% at 5 years and 91% vs 99% at 10 years (Log-rank p < 0.01). Conclusions: This report describes the natural history of the management and outcomes in men with a detectable PSA following RP. We demonstrate that men with a detectable PSA after RP may have excellent long-term outcomes.

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Radical Prostatectomy Versus Observation for Localized Prostate Cancer

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0007 ◽

2021 ◽

pp. 37-42

Author(s):

Philipp Dahm

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Watchful Waiting ◽

Specific Antigen ◽

Localized Prostate Cancer ◽

Disease Specific Survival ◽

Long Term Follow Up ◽

Disease Specific

This chapter provides a summary of the landmark PIVOT trial that randomized men with clinically localized prostate cancer from the early prostate-specific antigen (PSA) era to radical prostatectomy versus watchful waiting. Based on long-term follow-up, the study found that surgery provided only small reductions in disease-specific survival but caused substantial side effects. It suggested that many men with clinically localized prostate cancer fare well with watchful waiting.

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