The Study: Though most consider persistent PSA following radical prostatectomy a “failure,” there’s really not a ton of data on how these patients do with various subsequent treatments. In fact, the NCCN currently weigh salvage radiation and observation equally in this scenario. This large German single institution look at outcomes among >1K men with detectable PSA 6 weeks out from surgery aimed to capture long term disease outcomes and impact of salvage radiation. Outcomes at 15 years were indeed starkly different for those with persistent PSA at 6 weeks versus their >10K contemporaries with undetectable PSA: met-free survival was 53% versus 93%, respectively, and cancer-specific survival was 76% versus 96%. Among those with persistent PSA, propensity score-matching demonstrated cancer-specific (73 → 87%) and overall (82 → 94%) survival advantages at 10 years producing impressive multivariate hazard ratios of 0.12 and 0.37, respectively.
Bottom Line: Persistent PSA at 6 weeks out from prostatectomy is a very poor disease indicator with a significant improvement in outcomes seen after salvage radiation. | Preisser, Eur Urol 2019