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Association between PSA values and surveillance quality after prostate cancer surgery.

  • Chapman, Christina Hunter1, 2
  • Caram, Megan E V1, 3
  • Radhakrishnan, Archana4
  • Tsodikov, Alexander5
  • Deville, Curtiland6
  • Burns, Jennifer1
  • Zaslavsky, Alexander7
  • Chang, Michael8
  • Leppert, John T9
  • Hofer, Timothy1, 4
  • Sales, Anne E1, 10
  • Hawley, Sarah T1, 4
  • Hollenbeck, Brent K7
  • Skolarus, Ted A1, 7
  • 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.
Published Article
Cancer Medicine
Publication Date
Dec 01, 2019
DOI: 10.1002/cam4.2663
PMID: 31691526


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. 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. 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). 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. © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

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